Repeat Laparoscopic Paraaortic Lymphadenectomy for an Isolated Lymph Node Recurrence in a Patient with Stage IB2 Cervical Cancer

doi:10.1016/j.jmig.2009.07.015

Journal of Minimally Invasive Gynecology

Volume 16, Issue 6, November–December 2009, Pages 781-784

https://doi.org/10.1016/j.jmig.2009.07.015 Get rights and content

Abstract

We report a case of repeat laparoscopic paraaortic lymphadenectomy (LPAL) after surgery and concurrent chemoradiation of cervical cancer, FIGO stage IB2. Twelve months after the initial treatment, F-18 fluoro-deoxyglucose-positron emission tomography–computed tomography showed an isolated paraaortic lymph node recurrence in a 49-year-old woman. The lymph nodes were successfully removed in a repeat LPAL. The patient received 3 cycles of combination chemotherapy and showed a complete clinical recovery. Repeat LPAL is thus a feasible and effective procedure to remove and confirm of an isolated paraaortic lymph node recurrence after previous surgery and chemoradiation for treating cervical cancer.

Section snippets

Case Report

A 49-year-old woman, gravida 5, para 3, initially visited her gynecologist with postcoital vaginal bleeding that had lasted for 3 months. Diagnosis of an invasive SCC was confirmed with multiple punch biopsies. The patient was referred to our division for further evaluation and better treatment. Her medical history and surgical history were unremarkable. Bimanual pelvic examination revealed that the external cervical os was totally involved with the cancer mass. Fortunately, both parametria

Discussion

The incidence of radiologically detected isolated paraaortic lymph node recurrence after definitive therapy for invasive uterine cervical cancer varies from 1.7% to 12% [4]. However, because the diagnosis has not been verified by histopathologic diagnosis, the actual incidence is expected to be higher. Chemotherapy alone was believed to be inadequate in treating such asymptomatic recurrences, so cisplatin-based chemotherapy with concurrent paraaortic radiotherapy was introduced with good

Conclusions

Repeat LPAL is a feasible procedure for removal of an isolated paraaortic lymph node recurrence after previous surgery and chemoradiation for the cervical cancer treatment. Therefore the ability to perform systemic LPAL is an important skill for minimally invasive surgery in gynecologic oncology. Prospective randomized studies are needed to confirm the oncologic benefits and safety of repeat LPAL for patients with cervical cancer who show an isolated paraaortic lymph node recurrence.

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Cited by (5)

Can laparoscopic radical hysterectomy be a standard surgical modality in stage IA2-IIA cervical cancer?
2012, Gynecologic Oncology
Citation Excerpt :
Eight (6.8%) patients had recurrences or metastases (Table 3). Of these, four received chemotherapy, two received concurrent chemoradiation, one underwent a repeat LPAL for an isolated para-aortic lymph node recurrence [19], and the remaining patient with lung and brain metastasis underwent video-assisted thoracoscopic surgery and craniotomy. The survival data for each tumor stage were presented in Table 4.
To determine if laparoscopic radical hysterectomy (LRH) can be substituted for radical abdominal hysterectomy for women with International Federation of Gynecology and Obstetrics (FIGO) stage IA2–IIA cervical cancer.
We retrospectively reviewed the medical records of cervical cancer patients who underwent LRH with laparoscopic pelvic lymphadenectomy (LPL) and/or laparoscopic para-aortic lymphadenectomy (LPAL) from March 2003 to December 2011.
Of 118 enrolled patients, six were in FIGO stage IA2, 66 were in IB1, 41 were in IB2, one was in IIA1, and four were in IIA2. The median operating time, perioperative hemoglobin change, the number of harvested pelvic and para-aortic lymph nodes were 270 min (range, 120–495), 1.7 g/dL (range, 0.1–5), 26 (range, 9–55), and 7 (range, 1–39), respectively. There was no unplanned conversion to laparotomy. Intra- and postoperative complications occurred in 16 (13.5%) and 8 (6.7%) patients, respectively. In a median follow-up of 31 months (range, 1–89), 5-year recurrence-free and overall survival rates were 90% and 89%, respectively. Univariate analysis showed that cervical stromal invasion (P = 0.023) and lymph node metastasis (P = 0.018) affected survival rate. Cox-proportional hazards regression analysis showed that lymph node metastasis was the only independent factor for poor prognosis (hazard ratio = 7.0, P = 0.022).
LRH with LPL and/or LPAL in women with stage IA2–IIA cervical cancer is safe and feasible in terms of survival and morbidity. Our data suggest the need for larger prospective trials which could support this approach as a new standard of care for stage IA2–IIA cervical cancer.
Laparoscopic Lymphadenectomy for Isolated Lymph Node Recurrence in Gynecologic Malignancies
2012, Journal of Minimally Invasive Gynecology
Citation Excerpt :
Second-line chemotherapy was begun on day 4 after surgery. Currently, the patient is receiving outpatient follow-up and monitoring, and has been disease-free for 68 months [9]. Patient 2 was a 52-year-old woman, para 2, who had undergone primary staging surgery and adjuvant chemotherapy for ovarian cancer at another tertiary medical center.
To assess the feasibility and efficacy of laparoscopic lymphadenectomy in patients with isolated lymph node recurrences (ILNR) who underwent initial surgery because of gynecologic malignancy.
Retrospective study (Canadian Task Force classification II-3).
University teaching hospital.
Six patients with ILNR (1 cervical, 4 ovarian, and 1 peritoneal) diagnosed between March 2003 and July 2010.
Laparoscopic lymphadenectomy.
Median (range) patient age was 59.5 (24–70) years, and body mass index was 21.7 (21.0–24.6). There was no unplanned conversion to laparotomy. Operating time was 337.5 (200–400) minutes, hemoglobin change was 0.9 (0.4–2.6) g/dL, and hospital stay was 8.5 (5–19) days. The number of harvested lymph nodes was 20 (5–27), and of positive lymph nodes was 4 (1–24). One patient had common iliac vein laceration, with complete hemostasis achieved using intracorporeal suture. Postoperative lymphedema occurred in 1 patient, and was managed conservatively. All patients received adjuvant chemotherapy after laparoscopic lymphadenectomy.
Laparoscopic lymphadenectomy in patients with ILNR is feasible and might be an alternative therapeutic strategy.
Laparoscopic lymphadenectomy for gynecologic malignancies: Evaluation of the surgical approach and outcomes over a sevenyear experience
2012, Archives of Gynecology and Obstetrics
Comparison of survival and adverse events between women with stage IB1 and stage IB2 cervical cancer treated by laparoscopic radical vaginal hysterectomy
2012, Annals of Surgical Oncology
PET/CT Evaluation of cervical cancer: Spectrum of disease
2010, Radiographics

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Case ReportRepeat Laparoscopic Paraaortic Lymphadenectomy for an Isolated Lymph Node Recurrence in a Patient with Stage IB2 Cervical Cancer

Abstract

Section snippets

Case Report

Discussion

Conclusions

Gynecol Oncol

Gynecol Oncol

J Minim Invasive Gynecol

Int J Radiat Oncol Biol Physiol

Int J Radiat Oncol Biol Physiol

Int J Radiat Oncol Biol Physiol

Case Report
Repeat Laparoscopic Paraaortic Lymphadenectomy for an Isolated Lymph Node Recurrence in a Patient with Stage IB2 Cervical Cancer