Pedro T Ramirez, MD
Over the past 10 years, several studies have evaluated laparoscopy as an alternative to laparotomy for staging of cervical cancer. Compared with transperitoneal laparotomy, laparoscopic lymphadenectomy leads to fewer postoperative adhesion formations. Previous publications have shown that laparoscopic staging of patients with cervical cancer may change the therapeutic approach in up to 27% of patients. One problem of concern is the risk of adhesion formation when the procedure is performed transperitoneally. The transperitoneal approach places patients at risk for bowel complications from radiotherapy. Additionally, technical difficulties with mobilization and retraction of small bowel, adhesiolysis, mobilization of sigmoid colon for left sided node dissection, and ureteral identification may be tedious and contribute to a significant learning curve.
The purpose of our study is to determine the feasibility of performing an extraperitoneal laparoscopic lymphadenectomy in patients with stage IB2-IVA cervical carcinoma. We plan to document complication rates. In addition, we will correlate histopathological findings in the para-aortic lymph nodes with preoperative PET-CT imaging studies. Ultimately, our goal is to better refine the criteria for determining which patients will benefit from extended-field radiotherapy potentially decreasing the number of recurrences in this group of patients.