Role of pelvic and para-aortic lymphadenectomy in abandoned radical hysterectomy in cervical cancer
Barquet-Muñoz et al. World Journal of Surgical Oncology
Role of pelvic and para-aortic lymphadenectomy in abandoned radical hysterectomy in cervical cancer
Salim Abraham Barquet-Muñoz 3
Gabriel Jaime Rendón-Pereira 3
Denise Acuña-González 3
Monica Vanessa Heymann Peñate 3
Luis Alonso Herrera-Montalvo 3
Lenny Nadia Gallardo-Alvarado 3
David Francisco Cantú-de León 1 3 5
René Pareja 3 4
0 22 Col. Sección XVI Del. Tlalpan , Ciudad de Mexico CP 14080 , Mexico
1 Departamento de Ginecología Oncológica, Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan) , Av. San Fernando
2 43 C 110 , Medellin , Colombia
3 Mexico CP 14080 , Mexico
4 Clínica de Oncología ASTORGA , Calle 8
5 Departamento de Ginecología Oncológica, Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan) , Av. San Fernando
Background: Cervical cancer (CC) occupies fourth place in cancer incidence and mortality worldwide in women, with 560,505 new cases and 284,923 deaths per year. Approximately, nine of every ten (87%) take place in developing countries. When a macroscopic nodal involvement is discovered during a radical hysterectomy (RH), there is controversy in the literature between resect macroscopic lymph node compromise or abandonment of the surgery and sending the patient for standard chemo-radiotherapy treatment. The objective of this study is to compare the prognosis of patients with CC whom RH was abandoned and bilateral pelvic lymphadenectomy and para-aortic lymphadenectomy was performed with that of patients who were only biopsied or with removal of a suspicious lymph node, treated with concomitant radiotherapy/chemotherapy in the standard manner. Methods: A descriptive and retrospective study was conducted in two institutions from Mexico and Colombia. Clinical records of patients with early-stage CC programmed for RH with an intraoperative finding of pelvic lymph, para-aortic nodes, or any extracervical involvement that contraindicates the continuation of surgery were obtained. Between January 2007 and December 2012, 42 clinical patients complied with study inclusion criteria and were selected for analysis. Results: In patients with CC whom RH was abandoned due to lymph node affectation, there is no difference in overall survival or in disease-free period between systematic lymphadenectomy and tumor removal or lymph node biopsy, in pelvic lymph nodes as well as in para-aortic lymph nodes, when these patients receive adjuvant treatment with concomitant radiotherapy/chemotherapy. Conclusions: This is a hypothesis-generator study; thus, the recommendation is made to conduct randomized prospective studies to procure better knowledge on the impact of bilateral pelvic and para-aortic lymphadenectomy on this group of patients.
Cervical cancer; Abandoned radical hysterectomy; Systematic lymphadenectomy
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Background
Cervical cancer (CC) occupies fourth place in cancer
incidence and mortality worldwide in women, with
560,505 new cases and 284,923 deaths per year.
Approximately, nine of every ten (87%) of the latter take
place in developing countries [1]. In 2009, the
International Federation of Gynecology and Obstetrics
(FIGO) redefined CC staging, reiterating that this must
be clinical, to be more accessible to sectors and
countries with low resources [2]. However, it must be
considered that clinical staging entails a high percentage of
error, particularly in knowledge of the pelvic lymph
node and para-aortic involvement [3]. The National
Comprehensive Cancer Network (NCCN) recommends
radical hysterectomy (RH) with bilateral pelvic
lymphadenectomy (BPL) for patients with CC in early stages
(IA2–IB1) and who do not wish to preserve fertility; in
the case of finding lymph node or extracervical spread
during the surgical approach, the RH should be
suspended, in order to carry out a pathological
examination of the para-aortic lymph nodes and to administer
treatment with concomitant radiotherapy (RT) and
chemotherapy (ChemT) (RT/ChemT) [4]. The
Gynecologic Oncology Group (GOG) in 2000 published a
study where the main reason for suspending a RH in
patients with early stage CC was the presence of lymph
node involvement [5]. At present, studies have not
demonstrated the benefit of completing RH in the case
of trans-surgical findings of extra-cervix tumor spread
[6, 7]. However, para-aortic lymphadenectomy (PAL)
has the intent of surgical staging to establish the need
for extending radiation fields, although controversy
continues to exist concerning its usefulness in
prognosis [8]. In addition, there is controversy in the literature
between resect macroscopic lymph node compromise
or abandonment of the surgery and sending the patient
for standard radical treatment.
The objective of this study is to compare the prognosis
of patients with CC whom RH was abandoned and BPL
and PAL was performed, with that of patients who were
only biopsied or with removal of a suspicious lymph
node, (...truncated)