Comparison of retroperitoneal and transperitoneal surgical routes in laparoscopic nodal staging for locally advanced cervical cancers (FIGO IB3-IVA)

Marie Pécout (1) , Jérôme Phalippou (1) , Henri Azaïs (2) , Lobna Ouldamer (3, 4) , Pierre Adrien Bolze (5) , Marcos Ballester (6) , Cyrille Huchon (7) , Camille Mimoun (7) , Chérif Akladios (8) , Lise Lecointre (8) , Emilie Raimond (9) , Olivier Graesslin (9) , Xavier Carcopino (10, 11) , Vincent Lavoué (12, 13) , Sofiane Bendifallah (14, 15, 16) , Cyril Touboul (15, 14, 16) , Yohan Dabi (15, 14, 16) , Geoffroy Canlorbe (17) , Martin Koskas (18) , Pauline Chauvet (19) , Pierre Collinet (1) , Yohan Kerbage (1)

1 Hôpital Jeanne de Flandre [Lille]
2 HEGP - Hôpital Européen Georges Pompidou [APHP]
3 N2Cox - Niche, Nutrition, Cancer et métabolisme oxydatif
4 Hôpital Bretonneau
5 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
6 Groupe Hospitalier Diaconesses Croix Saint-Simon
7 Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]
8 HUS - Les Hôpitaux Universitaires de Strasbourg
9 Institut Mère Enfant Alix de Champagne
10 IMBE - Institut méditerranéen de biodiversité et d'écologie marine et continentale
11 Hôpital Nord [CHU - APHM]
12 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
13 OSS - Oncogenesis, Stress, Signaling
14 CHU Tenon [AP-HP]
15 Sorbonne Université - Faculté de médecine [CHU Pitié Salpétrière]
16 IUC - Institut Universitaire de Cancérologie [Sorbonne Université]
17 CHU Pitié-Salpêtrière [AP-HP]
18 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
19 CHU Clermont-Ferrand

BACKGROUND: This study compares morbidity and mortality associated with retroperitoneal and transperitoneal para-aortic lymphadenectomy (PAAL) for pretherapeutic nodal staging of locally advanced cervical cancers (FIGO IB3-IVA). METHODS: Pre-, per- and postoperative data of patients treated for locally advanced stage cervical cancer between 1999 and 2018 in 12 French referral centers (FRANCOGYN Study Group) were retrospectively collected. RESULTS: The study was conducted using a sample of 448 patients, of whom 223 (49,8%) underwent retroperitoneal (group 1) and 225 (50,2%) had transperitoneal PAAL (group 2). No differences were noted concerning clinical and histological characteristics between the two groups. Among these 448 patients, 23 (5,1%) had an intraoperative complication (9 (2,0%) in group 1 and 14 (3,1%) in group 2, p = 0.28) and 47 (10,5%) had a postoperative complication (22 (4,9%) in group 1 and 25 (5,6%) in group 2, p = 0.44), only one of which required revision surgery but the patient died. The length of hospital stay was significantly shorter in group 1 than in group 2 (3.97 versus 4.88 days, p < 0.001). There was no significant difference in mortality between the two groups; 34 of 223 patients in group 1 (15.3%) and 40 of 225 patients in group 2 (15.6%) died (HR = 0.968, 95% CI [0.591-1.585]). There was no significant difference in recurrence-free or overall survival between the two groups. CONCLUSION: Retroperitoneal PAAL appears as a valuable and safety surgical route for nodal staging in locally advanced cervical cancer compared with standard transperitoneal PAAL.

Domaines: Cancer

Marie Pécout, Jérôme Phalippou, Henri Azaïs, Lobna Ouldamer, Pierre Adrien Bolze, et al.. Comparison of retroperitoneal and transperitoneal surgical routes in laparoscopic nodal staging for locally advanced cervical cancers (FIGO IB3-IVA). EJSO - European Journal of Surgical Oncology, 2022, 48 (9), pp.2061-2067. ⟨10.1016/j.ejso.2022.05.005⟩. ⟨hal-03690683⟩