Implications of extraperitoneal paraaortic lymphadenectomy to the left renal vein in locally advanced cervical cancer. A Spanish multicenter study

• Published in: Gynecologic oncology 2020-08, Vol.158 (2), p.287-293
• Main Authors: Díaz-Feijoo, Berta, Franco, Silvia, Torné, Aureli, Benito, Virginia, Hernández, Alicia, Lago, Víctor, Rovira, Ramón, Acosta, Úrsula, Agustí, Nuria, Gil-Moreno, Antonio, Gil-Ibáñez, Blanca, Bebia, Vicente, Tejerizo, Álvaro, Pérez-Regadera, José F., Lubrano, Amina, González, Cristina, Domingo, Santiago, Ruiz, Rubén, Cobos, Paloma, Luna-Guibourg, Rocío, Gilabert-Estelles, Juan, Chipirliu, Anca, Llueca, Antonio, Piquer, Lola, Coronado, Pluvio, Gracia, Miriam
• Format: Article
• Language: English
• Subjects: Adult; Aorta, Thoracic; Female; Humans; Inferior mesenteric artery; Laparoscopic extraperitoneal paraaortic staging; Left renal vein; Locally advanced cervical cancer; Lymph Node Excision; Lymph Nodes - pathology; Lymph Nodes - surgery; Middle Aged; Minimally Invasive Surgical Procedures; Neoplasm Staging; Postoperative complications; Renal Veins; Retrospective Studies; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2020.05.004

Paraaortic lymph node involvement is an important prognostic factor in locally advanced cervical cancer (LACC), but the anatomic limit of aortic lymphadenectomy is controversial. We assessed the impact of extraperitoneal paraaortic lymphadenectomy up to the left renal vein in patients with LACC undergoing pretherapeutic staging. A retrospective, multicenter study of patients with LACC stages FIGO 2009 IB2 and IIA2-IVA treated in 10 Spanish reference hospitals in gynecological oncology between 2000 and 2016. Sites of metastatic paraaortic lymph nodes above or below the inferior mesenteric artery were evaluated. Procedural-related intraoperative and early and late complications were assessed. We included 634 patients undergoing paraaortic lymphadenectomy, in 616 (97.2%) of which the left renal vein was the upper limit of dissection (laparoscopy 592, robotic-assisted 24). The median surgical time was 150 min (interquartile range (IQR) 120–180), blood loss was 50 mL (range 20–80), and the length of stay was 2 days (range 2–3). Metastatic paraaortic involvement was found in 114 patients (18.5%), with infrarenal metastases in 73 (64%) of them. There were 11 patients (9.6%) with infrarenal metastases only, whereas in the remaining 62 (54.4%) patients concomitant infrarenal and inframesenteric metastases were observed. Intraoperative, early, and late postoperative complications occurred in 3.6%, 7.0%, and 4.5% of patients, respectively. In this study of patients with LACC undergoing surgical staging, paraaortic lymphadenectomy up to the left renal vein detected skip or isolated infrarenal metastasis in 9.6% of patients, with an acceptable surgical morbidity. •616 women with LACC underwent pretherapeutic extraperitoneal paraaortic lymphadenectomy up to the left renal vein.•Of 114 patients (18.5%) with paraaortic lymph node involvement, 73 (64%) had supramesenteric metastases.•There were 11 patients (9.6%) with isolated supramesenteric metastases.•The left renal vein should be considered as the optimal upper limit of pretherapeutic paraaortic lymphadenectomy for LACC.