Extraperitoneal para-aortic lymph node evaluation for cervical cancer via pfannenstiel incision: technique and peri-operative outcomes.

OBJECTIVE: To examine surgico-pathologic outcomes following extraperitoneal para-aortic lymph node dissection (EPLND) via pfannenstiel compared to paramedian incision prior to radiation in patients with cervical cancer.

METHODS: At our institution, patients with locally advanced cervical cancer undergo, EPLND. From 1990 to 2000, EPLND was performed via paramedian incision (PM) primarily to identify positive para-aortic lymph nodes (PALN). From 2000 to present, a complete pelvic and para-aortic lymphadenectomy was performed via pfannenstiel incision (PF). Records for all patients undergoing EPLND were reviewed. Pathologic findings, post-operative complications, and time to initiation of radiation (TRT) were abstracted.

RESULTS: 93 patients underwent EPLND, 48 via PF and 45 via PM incision. The mean age and body mass index did not differ between the two groups. Stage distribution was similar: IB2 8 vs. 0%; IIB 44 vs. 44%; IIIA/B 35 vs. 44%; IVA 13 vs. 11%, respectively. Positive PALN were identified in 44% of PF patients and 29% of PM patients (p=ns). TRT was not significantly different at 36.4 vs. 28.8 days, respectively. There were more complications among the PF group including cellulitis and lymphocyst formation. Pre-treatment computed tomography (CT) scan had positive and negative predictive values of only 86 and 66% for evaluation of PALN involvement.

CONCLUSIONS: We present an extraperitoneal method for removal of the pelvic and para-aortic lymph nodes with acceptable complications and no significant delay to initiate chemoradiation. Accurate assessment of lymphatic metastases results in modification of the radiation field, which, along with surgical debulking, may impact overall survival.