Laparoscopic surgery in treatment of Stage Ilb cervical cancer after neoadjuvant chemotherapy. A case report and review of the literature

Background: A detailed operative procedure of laparoscopic radical hysterectomy (type III) with pelvic and aortic lymphadenectomy after neoadjuvant chemoterapy in treatment of Stage IIb cervical cancer is described.

Case report: A 50-year-old patient with Stage IIb squamous cell carcinoma of the uterine cervix, who initially was not surgically resectable, received three courses of neoadjuvant chemotherapy that included ifosfamide 5 g/m2, cisplatin 50 mg/m2 and paclitaxel 175 mg/m2 (TIP). Following a partial clinical response to chemotherapy, the patient underwent laparoscopic type III radical hysterectomy with bilateral salpingo-oophorectomy and pelvic and paraaortic lymphadenectomy. The surgical procedure lasted 250 minutes. Blood loss was 310 ml. The patient was discharged on postoperative day 4. The mean length of the resected parametria and paracolpia was 4.1 cm and 2.0 cm, respectively. The number of dissected lymph nodes was 48:29 pelvic and 19 paraaortic nodes. No major intraoperative or postoperative complications occurred. The patient also underwent adjuvant radiation therapy. Follow-up was performed at six months so far.

Conclusions: This experience suggests that such a surgical procedure is safe. Laparoscopic radical hysterectomy potentially allows for decreased perioperative morbidity and blood loss, faster recovery and better cosmetic results. Large studies with long term follow-up are needed to confirm that this approach may be proposed as an alternative to conventional surgery.

Cervical cancer; Neoadjuvant chemotherapy; Laparoscopy; Radical hysterectomy

[1] Childers J.M., Hathch K.D., Surwit E.A.: "The role of laparoscopie lymphadenectomy in the management of cervical carcinoma" Gynecol. Oneal., 1992, 47, 38.

[2] Dargent D.: "Laparoscopy surgery and gynecologic cancer". Curr. Opin. Obstet. Gynecol., 1993, 5, 294.

[3] Possover M., Krause N., Plaul K., Kuhne-Heid R., Schneider A.: "Laparoscopic para-aortic and pelvic lymphadenectomy: experience with 150 patients and review of the literature". Gynecol. Oneal., 1998, 71.

[4] Nezhat C.R., Nezhat F.R.. Burrell M.O., Ramirez C.E., Welander C., Carrodeguas J. et al.: "Laparoscopic radical hysterectomy and laparoscopically assisted vaginal radical hysterectomy with paraaortic and pelvic node dissection". J. Gynecol. Surg., 1993, 9, 105.

[5] Spirtos N.M., Eisenkop S.M., Schlaerth J.B., Ballon S.C.: "Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy in patients with stage I cervical cancer: surgical morbibity and intermediate follow-up". Am. J. Obstet. Gynecol., 2002, 187, 340.

[6] Sedlacek T.V., Campion M.J., Hutchins R.A., Reich H.: "Laparoscopic radical hysterectomy: a preliminary report". J. Am. Assoc Gynecol. Lapa rose., 1994, I (4, part. 2), s37.

[7] Burghardt E.: "Prognostic factors and operative treatment of stages lb to Ilb cervical cancer". Am. J. Obstet. Gynecol., 1987, 15 (66), 988.

[8] Benedetti Panici P.B., Scambia G., Baiocchi G., Greggi S., Ragusa G., Gallo A. et al.: "Neoadjuvant chemotherapy and radical surgery in locally advanced cervical cancer". Cancer, 1991, 67, 3.

[9] Leveuf J., Godard H.: "Les lympatiques de !'uterus". Rev. Chir., 1923, 219.

[10] Possover M., Stober S., Plaul K., Schneider A.: "Identification and preservation of the motoric innervation of the bladder in radical hysterectomy type III". Gynecol. Oneal., 2000, 79, 154.

[11] Canis M., Mage G., Pouly J.L., Pomel C., Wattiez A., Glowaczover E. et al.: "Laparoscopic radical hysterectomy for cervical cancer". Baillieres Clin. Obstet. Gynaecol., 1995, 9, 675.

[12] Hsieh Y.Y., Lin W.C., Chang C.C., Yeh L.S., Hsu T.Y., Tsai H.D.: "Laparoscopic radical hysterectomy with low paraaortic, subaortic and pelvic lymphadenectomy. Results of short-term follow-up". J Reprod. Med., 1998, 528.

[13] Kim D.H., Moon J.S.: "Laparoscopic radical hysterectomy with pelvic lymphadenectomy for early, invasive cervical carcinoma". J. Am. Assoc. Gynecol. Laparosc., 1998, 5 (4), 411.

[14] Vidal 0., Garza-Leal J.G.: "Laparoscopy versus laparotomy for radical hysterectomy". J. Am. Assoc. Gynecol. Laparosc., 1996, 3 (4 suppl.), S53.

[15] Eisenkop S., Spirtos N., Montag T., Moossazedeh J., Warren P., Hendrikcsen M.: "The clinical significance of blood transfusion at the time of radical hysterectomy". Obstet. Gynecol., 1990, 76, 110.

[16] Benedetti-Panici P., Scambia G., Baiocchi G., Maneschi F., Greggi S., Mancuso S.: "Radical hysterectomy: a randomized study comparing two techniques for resection of the cardinal ligament". Gynecol. Oneal., 1993, 50, 226.

[17] Schlaert J.B.. Spirtos N.M., Boike G.M., Fowler J.M.: "Laparoscopic retroperitoneal lymphadenectomy followed by laparotomy in women with cervical cancer (abstract)". Gynecol. Oneal., 1999, 72, 443.

[18] Van Nagell J.R., Donaldson E.S., Wood E.G.:'The significance of vascular invasion and lymphocystic infiltration invasive cervical cancer". Cancer, 1978, 4, 228.

[19] Hogan W.M., Littman P., Griner L., Miller C.L., Mikuta J.J.: "Results of radiation therapy given after radical hysterectomy". Cancer, 1982, 15, 49 (6), 1278.

[20] Kadar N.: "Port-site recurrences following laparoscopic operallons for gynaecological malignancies". Br. J. Obstet. Gynaecol., 1997, 104, 1308.

[21] Agostini A., Cohen D., Cravello L., Bretelle F., Roger V.. Blanc B.: "Port-site recurrence following laparoscopic para-aortic lymphadenectomy for squamous carcinoma of the cervix". Eur. J. Obstet. Gynecol. Rep rod. Biol., 200 I, 98, 258.

[22] Lavie O., Cross P.A., Beller U., Dawlatly B., Lopes A., Monaghan J.M.: "Laparoscopic port-site metastasis of an early stage adenocarcinoma of the cervix with negative lymph nodes". Gynecol. Oneal., 1999, 75, 155.

[23] Wang P.H., Yuan C.C., Lin G., Ng H.T., Chao H.T.: "Risk factors contributing to early occurrence of port site metastases of laparoscopic surgery for malignancy". Gynecol. Oneal, 1999, 72, 38.

[24] Kohlbergher P.O., Edwards L., Collins C., Milross C.. Hacker N.F.: "Laparoscopic port site recurrence following surgery for a stage lb squamous cell carcinoma of the cervix with negative lymph nodes". Gynecol. Oneal., 2000., 79, 324.