Laparoscopic para-aortic and pelvic lymphadenectomy and radical hysterectomy in a patient with cervical cancer, six months after primary chemoradiation. Zygouris D, Kotsopoulos IC, Chalvatzas N, Maltaris T, Kartsiounis V, Kavallaris A. Eur J Gynaecol Oncol. 2013;34(5):484-6. PMID: 24475590 [PubMed – indexed for MEDLINE]

Title:

Description:

Laparoscopic para-aortic and pelvic lymphadenectomy and radical hysterectomy in a patient with cervical cancer, six months after primary chemoradiation. Zygouris D, Kotsopoulos IC, Chalvatzas N, Maltaris T, Kartsiounis V, Kavallaris A. Eur J Gynaecol Oncol. 2013;34(5):484-6. PMID: 24475590 [PubMed – indexed for MEDLINE]

Abstract
Treatment of Stage IB-IIA cervical carcinoma is controversial. The
choice to perform surgery or chemoradiation depends on the FIGO
Stage, which does not include evaluation of lymph node involvement,
although the prognosis of the patients depends on this evaluation.
There is no method however, to safely evaluate preoperative lymph
nodes metastasis, as both magnetic resonance imaging (MRI) and
computed tomography (CT) have poor sensitivity and high
specificity. As a result, inaccurate preoperative lymph node
assessment can lead to suboptimal treatment. The authors report the
case of a 42-year-old patient with cervical cancer Stage IB2, who
was primary treated with chemoradiation. Although at the time of
diagnosis no lymph node metastasis was detected, six months after
treatment, an enlarged five-cm lymph node was found in the area of
left iliac vein. The patient underwent laparoscopic pelvic and
para-aortic lymphadenectomy and nerve sparing radical hysterectomy.
Pathologic examination revealed one positive lymph node out of the
41 removed and no cancer cells in the uteral structures. There are
cases of cervical cancer in which chemoradiation seems to be
insufficient. Laparoscopic nerve-sparing radical hysterectomy can
be the treatment in patients with lymph node metastasis after
primary chemoradiation. It offers oncological safety combining the
advantages of laparoscopy and the nerve-sparing technique.
Furthermore, adjuvant chemotherapy or radiation can be initiated
immediately, offering the best therapeutical choice in the authors’
opinion. PMID: 24475590 [PubMed – indexed for MEDLINE]

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