TY - JOUR
T1 - Implications of extraperitoneal paraaortic lymphadenectomy to the left renal vein in locally advanced cervical cancer. A Spanish multicenter study
AU - Díaz-Feijoo, Berta
AU - Franco, Silvia
AU - Torné, Aureli
AU - Benito, Virginia
AU - Hernández, Alicia
AU - Lago, Víctor
AU - Rovira, Ramón
AU - Acosta, Úrsula
AU - Agustí, Nuria
AU - Gil-Moreno, Antonio
AU - Gil-Ibáñez, Blanca
AU - Bebia, Vicente
AU - Tejerizo, Álvaro
AU - Pérez-Regadera, José F.
AU - Lubrano, Amina
AU - González, Cristina
AU - Domingo, Santiago
AU - Ruiz, Rubén
AU - Cobos, Paloma
AU - Luna-Guibourg, Rocío
AU - Gilabert-Estelles, Juan
AU - Chipiriliu, Dra
AU - Llueca, Antonio
AU - Piquer, Lola
AU - Coronado, Pluvio
AU - Gracia, Miriam
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/8
Y1 - 2020/8
N2 - Objective: Paraaortic lymph node involvement is an important prognostic factor in locally advanced cervical cancer (LACC), but the anatomic limit of aortic lymphadenectomy is controversial. We assessed the impact of extraperitoneal paraaortic lymphadenectomy up to the left renal vein in patients with LACC undergoing pretherapeutic staging. Methods: A retrospective, multicenter study of patients with LACC stages FIGO 2009 IB2 and IIA2-IVA treated in 10 Spanish reference hospitals in gynecological oncology between 2000 and 2016. Sites of metastatic paraaortic lymph nodes above or below the inferior mesenteric artery were evaluated. Procedural-related intraoperative and early and late complications were assessed. Results: We included 634 patients undergoing paraaortic lymphadenectomy, in 616 (97.2%) of which the left renal vein was the upper limit of dissection (laparoscopy 592, robotic-assisted 24). The median surgical time was 150 min (interquartile range (IQR) 120–180), blood loss was 50 mL (range 20–80), and the length of stay was 2 days (range 2–3). Metastatic paraaortic involvement was found in 114 patients (18.5%), with infrarenal metastases in 73 (64%) of them. There were 11 patients (9.6%) with infrarenal metastases only, whereas in the remaining 62 (54.4%) patients concomitant infrarenal and inframesenteric metastases were observed. Intraoperative, early, and late postoperative complications occurred in 3.6%, 7.0%, and 4.5% of patients, respectively. Conclusions: In this study of patients with LACC undergoing surgical staging, paraaortic lymphadenectomy up to the left renal vein detected skip or isolated infrarenal metastasis in 9.6% of patients, with an acceptable surgical morbidity.
AB - Objective: Paraaortic lymph node involvement is an important prognostic factor in locally advanced cervical cancer (LACC), but the anatomic limit of aortic lymphadenectomy is controversial. We assessed the impact of extraperitoneal paraaortic lymphadenectomy up to the left renal vein in patients with LACC undergoing pretherapeutic staging. Methods: A retrospective, multicenter study of patients with LACC stages FIGO 2009 IB2 and IIA2-IVA treated in 10 Spanish reference hospitals in gynecological oncology between 2000 and 2016. Sites of metastatic paraaortic lymph nodes above or below the inferior mesenteric artery were evaluated. Procedural-related intraoperative and early and late complications were assessed. Results: We included 634 patients undergoing paraaortic lymphadenectomy, in 616 (97.2%) of which the left renal vein was the upper limit of dissection (laparoscopy 592, robotic-assisted 24). The median surgical time was 150 min (interquartile range (IQR) 120–180), blood loss was 50 mL (range 20–80), and the length of stay was 2 days (range 2–3). Metastatic paraaortic involvement was found in 114 patients (18.5%), with infrarenal metastases in 73 (64%) of them. There were 11 patients (9.6%) with infrarenal metastases only, whereas in the remaining 62 (54.4%) patients concomitant infrarenal and inframesenteric metastases were observed. Intraoperative, early, and late postoperative complications occurred in 3.6%, 7.0%, and 4.5% of patients, respectively. Conclusions: In this study of patients with LACC undergoing surgical staging, paraaortic lymphadenectomy up to the left renal vein detected skip or isolated infrarenal metastasis in 9.6% of patients, with an acceptable surgical morbidity.
KW - Inferior mesenteric artery
KW - Laparoscopic extraperitoneal paraaortic staging
KW - Left renal vein
KW - Locally advanced cervical cancer
KW - Postoperative complications
KW - Inferior mesenteric artery
KW - Laparoscopic extraperitoneal paraaortic staging
KW - Left renal vein
KW - Locally advanced cervical cancer
KW - Postoperative complications
KW - Inferior mesenteric artery
KW - Laparoscopic extraperitoneal paraaortic staging
KW - Left renal vein
KW - Locally advanced cervical cancer
KW - Postoperative complications
UR - http://www.scopus.com/inward/record.url?scp=85085350959&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2020.05.004
DO - 10.1016/j.ygyno.2020.05.004
M3 - Article
C2 - 32467055
AN - SCOPUS:85085350959
SN - 0090-8258
VL - 158
SP - 287
EP - 293
JO - Gynecologic Oncology
JF - Gynecologic Oncology
IS - 2
ER -