LAUSR

STUDY OBJECTIVE To evaluate laparoscopic pelvic lymph node debulking during extraperitoneal aortic lymphadenectomy in diagnosis, therapeutic planning and prognosis of patients with locally advanced cervical cancer and enlarged lymph nodes on imaging prior to chemoradiotherapy. DESIGN Retrospective, multicenter, comparative cohort study. SETTING The study was carried out at 11 hospitals with specialized gynecological oncology units in Spain. PATIENTS Three hundred and eighty one women with locally advanced cervical cancer and FIGO 2018 stage IIIC 1''r'' (radiologic) and higher who received primary treatment with chemoradiotherapy. INTERVENTIONS Patients underwent pelvic lymph node debulking and paraaortic lymphadenectomy (group 1), only paraaortic lymphadenectomy (group 2), or no lymph node surgical staging (group 3). Based on pelvic node histology, group 1 was subdivided in negative (group 1A) or positive (group 1B). MEASUREMENTS False positives and negatives of imaging tests, disease-free survival (DFS), overall survival (OS) and postoperative complications were evaluated. MAIN RESULTS . In group 1, pelvic lymph node involvement was 43.3% (71/164) and aortic involvement was 24.4% (40/164). In group 2, aortic nodes were positive in 29.7% (33/111). DFS and OS were similar in the 3 groups (p0.95) and in groups 1A and 1B (p0.25). No differences were found between groups 1 and 2 in intraoperative (3.7% vs. 2.7%, p0.744), early postoperative (8.0% vs. 6.3%, p0.776), or late postoperative complications (6.1% vs. 2.7%, p0.252). Fewer early and late complications were attributed to radiotherapy in group 1A than in the others (p0.022). CONCLUSIONS Laparoscopic pelvic lymph node debulking during paraaortic staging surgery in locally advanced cervical cancer patients with suspicious nodes allows confirmation of metastatic lymph nodes without affecting survival or increasing surgical complications. This information improves selection of patients requiring boost irradiation, thus avoiding overtreatment of patients with negative nodes.