Pretreatment laparoscopic surgical staging in locally advanced cervical cancer: preliminary results in Korea

OBJECTIVES: The purpose of this study was to evaluate the feasibility and efficacy of pretreatment laparoscopic surgical staging in the treatment of locally advanced cervical cancer. METHODS: Forty-four patients with locally advanced cervical cancer who underwent pretreatment laparoscopic surgical staging between October 2001 and April 2004 were reviewed. The pathological diagnosis after laparoscopic surgical staging was compared with results from preoperative magnetic resonance imaging (MRI), and surgical results with follow-up data were evaluated. RESULTS: The mean duration of surgery was 202.0 (range: 120-300) min and the mean number of harvested lymph nodes (LNs) was 38.7 (range: 20-75). Twenty (45.5%) patients had pelvic LN metastasis and 5 (11.4%) patients had pelvic and para-aortic LN metastasis. Region-specific findings of MRI resulted in sensitivity and positive predictive values of 55.9% and 48.7%, respectively, on a three-region analysis. When compared with MRI, laparoscopic surgical staging was superior in detecting microscopic LN metastasis. The time to commencing concurrent chemoradiotherapy after laparoscopic surgical staging was 8.6 +/- 3.3 (mean +/- SD) days. All the patients received concurrent chemoradiotherapy as scheduled. There were three (6.8%) cases of minor postoperative complications, and no mortality occurred during the follow-up period. The 2-year disease-free survival rate of the current study was 89.7%, and three (6.8%) patients experienced recurrence after treatment. CONCLUSIONS: Laparoscopic surgical staging in locally advanced cervical cancer is a feasible and safe pretreatment method, and can be used as a best guideline for individualized concurrent chemoradiotherapy.