Lokal İleri Serviks Kanserinde Laparoskopik Ekstraperitoneal Para-aortik Lenfadenektomi: Pros- pektif Tek Merkezli Bir Çalışma

Öz

Amaç: Lokal ileri serviks kanserli (LİSK) hastalarda laparoskopik ekstraperitoneal para-aortik lenfadenektominin teknik

uygulanabilirliğini ve perioperatif güvenliğini değerlendirmek; ikincil olarak patolojik bulguları, ¹⁸F-FDG PET/BT–pato-

loji uyumunu ve tedavi planlamasına etkisini incelemek.

Gereç ve Yöntem: Bu prospektif, tek merkezli gözlemsel çalışmaya, kesin kemoradyoterapi öncesinde laparoskopik

ekstraperitoneal para-aortik lenfadenektomi uygulanan, histolojik olarak doğrulanmış LİSK tanılı ardışık 21 hasta dahil

edildi. Tüm hastalara preoperatif PET/BT yapıldı. Cerrahi olarak çıkarılan para-aortik lenf nodlarının histopatolojisi

referans standart olarak kabul edildi. Oranlar %95 güven aralıklarıyla (GA) verildi.

Bulgular: İşlem 21 hastanın 20’sinde (%95,2) ekstraperitoneal laparoskopik yolla tamamlandı. Bir hastada (%4,8)

intraoperatif vena kava inferior yaralanması nedeniyle laparotomiye dönüldü; tek majör komplikasyon buydu ve

kemoradyoterapiyi geciktirmedi. Medyan ameliyat süresi 132 dakika, tahmini kan kaybı 35 mL, lenf nodu sayısı 12

(aralık, 7–21), hastanede kalış 2 gün ve kesin kemoradyoterapiye kadar geçen süre 12 gün idi. Beş hastada (%23,8)

histopatolojik para-aortik metastaz saptandı. Görüntülemede para-aortik negatif 18 hastanın 3’ünde (%16,7) okült

metastaz bulundu. PET/BT’nin para-aortik metastaz için duyarlılığı %40,0 (%95 GA 11,8–76,9), özgüllüğü %93,8

(%95 GA 71,7–98,9) idi. Cerrahi evreleme 4 hastada (%19,0) planlanan tedaviyi değiştirdi: okült metastazlı 3 hasta-

da radyoterapi alanı genişletildi, PET/BT-pozitif nodları histolojik olarak negatif çıkan 1 hastada genişletilmiş alan

radyoterapisinden vazgeçildi.

Sonuç: Laparoskopik ekstraperitoneal para-aortik lenfadenektomi seçilmiş LİSK hastalarında düşük morbidite ile uygu-

lanabilir bulundu ve PET/BT’nin saptayamadığı okült para-aortik metastazları ortaya koydu. Tedavi değişikliği bir karar

vekil ölçütüdür ve sağkalım yararı olarak yorumlanmamalıdır.

Laparoscopic Extraperitoneal Para-aortic Lymphadenectomy in Locally Ad- vanced Cervical Cancer: A Prospective Single-Center Study

Öz

Objective: To evaluate the technical feasibility and perioperative safety of laparoscopic extraperitoneal para-aortic

lymphadenectomy in patients with locally advanced cervical cancer (LACC), and secondarily to assess pathological

findings, ¹⁸F-FDG PET/CT–pathology concordance, and impact on treatment planning.

Materials and Methods: This prospective single-center observational study included 21 consecutive patients with

histologically confirmed LACC who underwent laparoscopic extraperitoneal para-aortic lymphadenectomy before de-

finitive chemoradiotherapy. All patients had preoperative PET/CT. Histopathology of retrieved para-aortic nodes was

the reference standard. Proportions are reported with 95% confidence intervals (CI).

Results: The procedure was completed via the extraperitoneal laparoscopic route in 20 of 21 patients (95.2%); one

conversion to laparotomy (4.8%) for an intraoperative inferior vena cava injury was the only major complication and

did not delay chemoradiotherapy. Median operative time was 132 minutes, estimated blood loss 35 mL, lymph node

yield 12 (range, 7–21), hospital stay 2 days, and time to definitive chemoradiotherapy 12 days. Para-aortic metastases

were confirmed histopathologically in 5 patients (23.8%). Among 18 patients with imaging-negative para-aortic nodes,

occult metastases were found in 3 (16.7%). PET/CT sensitivity for para-aortic metastasis was 40.0% (95% CI 11.8–76.9)

and specificity 93.8% (95% CI 71.7–98.9). Surgical staging modified the planned treatment in 4 patients (19.0%): field

extension in 3 with occult metastasis and omission of extended-field radiotherapy in 1 with histologically negative

PET/CT-positive nodes.

Conclusion: Laparoscopic extraperitoneal para-aortic lymphadenectomy was feasible with low morbidity in selected

patients with LACC and identified occult para-aortic metastases not detected by PET/CT. Treatment modification is a

decision-making surrogate and should not be interpreted as a survival benefit.

Anahtar Kelimeler

• Atypical Placental Site Nodule
• Cesarean section scar
• Intermediate trophoblastic tumor
• Isthmocele

Kaynakça

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