The indication and surgery scope for laparoscopic extraperitoneal lymphadenectomy in locally advanced cervical cancer
10.3760／cma.j.issn.0253?3766.2019.04.011
- VernacularTitle:局部晚期宫颈癌腹膜后淋巴结切除的适应证和手术范围
- Author:
Meiling ZHONG
1
;
Meirong LIANG
;
Wei JIANG
;
Yanan WANG
;
Yang ZENG
;
Siyuan ZENG
Author Information
1. 江西省妇幼保健院肿瘤科
- Keywords:
[Subject words] Cervical neoplasms;
Tomography,spiral computed;
Extraperitoneal lymphadenectomy;
Serum squamous cell cancer?Ag
- From:
Chinese Journal of Oncology
2019;41(4):303-308
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the indication and surgery scope for laparoscopic extraperitoneal lymphadenectomy in locally advanced cervical cancer. Methods Laparoscopic extraperitoneal lymphadenectomy was initially performed on patients with locally advanced cervical cancer. The results of preoperative computed tomography (CT) images and serum level of squamous cell carcinoma antigen (SCC?Ag) were analyzed, and the diagnostic efficiencies of the minimum axial diameter (MAD) of lymph node on CT≥0.5 cm,≥1.0 cm, serum level of SCC?Ag alone or combined to predict the extraperitoneal lymph node metastases were compared. The high?risk factors of common iliac lymph node (CILN) and para?aortic lymph node ( PALN) metastases were also analyzed. Results The lymph node metastasis rate of 81 patients who received the laparoscopic extraperitoneal lymphadenectomy was 59.3%(48／81). The CILN and／or PALN metastasis rate was 24.7%(20／81), and among them, the MAD of CILN and／or PALN ≥0.5 cm on CT images were in only 7 patients. The threshold of SCC?Ag for evaluating lymph node metastasis was 4.8 ng／ml. The accuracy, specificity and Youden index of SCC?Ag≥4.8+MAD≥1.0 cm group for predicting lymph node metastasis were 78.3%, 100% and 0.6, respectively, and were significantly higher than 57.9%, 12.1% and 0.1 of MAD≥0.5 cm group, 71.1%, 75.8% and 0.4 of MAD≥1.0 cm group, 65.0%, 57.7% and 0.3 of SCC?Ag≥4.8 ng／ml group and 68.3%, 65.4% and 0.4 of SCC?Ag≥4.8 ng／ml+MAD≥0.5 cm group ( P＜0.05). All of the 21 patients in SCC?Ag≥4.8 ng／ml+MAD≥1.0 cm group were detected to occur lymph node metastases, and the metastasis rate of CILN and／or PALN was 38.1%. While only 4 cases of 17 patients in SCC?Ag＜4.8 ng／ml+MAD＜1 cm group were confirmed to occur CILN metastases. The difference of lymph node metastasis rate between these two groups was statistically significant (P＜0.001).The pathological type, the number of PLN with MAD≥1.0 cm, at least one of the PLN MAD≥1.0 cm and／or MAD of CILN and／or PALN was 0.5～1.0 cm were associated with the CILN and／or PALN metastases ( all P＜0.05). Conclusions Those patients with MAD≥1.0 cm+SCC?Ag≥4.8 ng／ml and with high?risk factors of CILN and／or PALN metastases should undergo laparoscopic extraperitoneal lymphadenectomy to provide explicit guidance for the subsequent therapy. However, the incidence of lymph node metastasis of patients with SCC?Ag＜4.8 ng／ml combined with MAD＜1.0 cm is low, therefore these patients can accept concurrent chemoradiotherapy directly.
