Dados do Trabalho

Título

TRANSPERITONEAL LAPAROSCOPIC PELVIC LYMPH NODE DEBULKING FOR STAGE IIIC1 CERVICAL CANCER

Introdução

Patients with advanced cervical cancer with lymph node enlargement are classified as FIGO 2018 staging IIIC1 or IIIC2, when positive pelvic or paraaortic lymph nodes are detected, respectively.

These patients are candidates for combined treatment with chemotherapy and radiotherapy, with or without inductive chemotherapy. However, some studies suggest a role of lymph node debulking, with acceptable morbidity and higher rates of tumor sterilization.

Objetivo

This video demonstrates a transperitoneal laparoscopic pelvic lymph node debulking with permanent instruments for a patient with FIGO 2018 stage IIIC1 cervical cancer.

Casuística

This video demonstrates a transperitoneal laparoscopic pelvic lymph node debulking with permanent instruments for a patient with FIGO 2018 stage IIIC1 cervical cancer.

Método

The patient, under general anesthesia, was placed in a low lithotomy position, with arms along the body and lower limbs in Allen stirrups. One 11mm trocar was inserted in the umbilical site, and three other 5mm trocars in the lower quadrants.
Enlarged nodes were observed transperitoneally as soon as a Trendelemburg was settled.
An incision was performed in the right pelvic peritoneum to access the pelvic retroperitoneum space, allowing lateral to medial right ureteric identification. The ureter was medialized, with adequate enlarged lymph node exposure. A dissection of the right external iliac artery was performed to improve access to the tumor laterally and medially.

The dissection was performed with a suction device to identify the right internal iliac artery, which was separated from the tumor. This was the anatomical landmark to approach the tumor and complete its dissection from the right common iliac artery bifurcation. Medial traction of the tumor and cranial dissection were performed until access to the obturator fossa allowed the identification of the obturator nerve. After confirmation of the anatomical landmarks, the final removal of the enlarged lymph node was performed.

Resultados

Locally advanced cervical cancer should be managed with chemoradiation, with or without neoadjuvant chemotherapy. In selected cases, lymph nodes conglomerate with more than 2 cm in the short diameter may benefit from minimally invasive debulking, with acceptable morbidity.

Conclusões

This video demonstrates a safe pelvic nodal debulking with a transperitoneal laparoscopic approach using permanent instruments.

Conflitos de interesse

Não há

Referências

1 Sakuragi N, Satoh C, Takeda N, et al. Incidence and distribution pattern of pelvic and paraaortic lymph node metastasis in patients with Stages IB, IIA, and IIB cervical carcinoma treated with radical hysterectomy. Cancer. Vol. 85, no. 7, 1 Apr. 1999, pp. Availablehttps://doi.org/10.1002/(sici)10970142(19990401)85:7%3C1547::aid-cncr16%3E3.0.co;2-2.

2 Bang-xing HUANG, Fang FANG. Progress in the Study of Lymph Node Metastasis in Early-stage Cervical Cancer. Current Medical Science 38(4):567-574,2018. Available https://pubmed.ncbi.nlm.nih.gov/30128863/

3 R Tozzi F Lavra, T Cassese, R Garruto Campanile, V Pedicini, M Bignardi, M Scorsetti, A Bertuzzi. Laparoscopic debulking of bulky lymph nodes in women with cervical cancer: indication and surgical outcomes. BJOG. . 2009 Apr;116(5):688-92. Aveileble: doi: 10.1111/j.1471-0528.2008.02032.x. Epub 2009 Feb 10.

Palavras Chave

câncer de colo de útero; Cirurgia oncológica; METÁSTASE LINFONODAL