Our Experience of Laparoscopic Anterior Exenteration in Locally Advanced Cervical Carcinoma

Abstract

Study objective: To show the feasibility, technique, and results of laparoscopic anterior exenteration in selected patients.

Design: A retrospective cohort study.

Setting: Galaxy Care Laparoscopy Institute, Pune, India.

Patients: Seventy-four of 85 patients who underwent laparoscopic anterior exenteration for stage IVA carcinoma of the cervix from January 2005 to January 2015 were analyzed; the median follow-up was 30 months. Contrast-enhanced computed tomographic imaging of the abdomen and pelvis was performed for all patients.

Interventions: The same surgeon and team performed all the operations for uniformity in 10 operative steps.

Measurements and main results: The mean operative time was 180 minutes, and the mean blood loss was 160 mL. The mean hospital stay was 6 days. The average number of lymph nodes removed was 21.4. Surgical margins were negative in all patients. Forty-two patients had positive lymph nodes. Chemoradiation was given to those with positive lymph nodes. Perioperative complications occurred in 15 (20.27%) patients including deep vein thrombosis, urinary tract infection, ureterosigmoid leak (n = 2/74), and so on. Positron emission tomographic imaging and computed tomographic scanning were performed at 6 months after surgery and 6 months after adjuvant therapy in those with positive lymph nodes. There was no immediate postoperative mortality. The overall survival rate at 5 years was 25%.

Conclusion: Laparoscopic anterior exenteration is feasible in cases of advanced carcinoma of the cervix. Results have shown that in selected patients this procedure is associated with good long-term survival.

Keywords: Advanced carcinoma cervix; Laparoscopic anterior exenteration; Palliation; Ureterosigmoidostomy.