Tolga ÇİFTPINAR, Faruk KÖSE, Mufit Cemal YENEN
Gulhane Medical Journal - 2026;68(2):94-101
Aims: This study aimed to compare imaging-based evaluation of retroperitoneal nodal status with pathologic findings, and to identify the advantages and disadvantages of laparoscopy. Methods: This retrospective study included patients with invasive cervical cancer who underwent laparotomy or extraperitoneal laparoscopy for evaluation of para-aortic nodal status between 2002 and 2006 at two tertiary care hospitals. The primary objectives were to compare the imaging modalities with pathological findings and laparoscopy with laparotomy. Results: Forty-one women (mean age: 51+/-10 years) having invasive cervical cancer were included in the study. Laparoscopic extraperitoneal lymphadenectomy was performed in 26 patients [International Federation of Gynecology and Obstetrics (FIGO) stage IIB-IIIB], and laparotomic hysterectomy and para-aortic lymphadenectomy were performed in 15 patients (FIGO stage IB-IIB). Operation times (115.1 minutes vs. 182.0 minutes, p<0.001), the average length of hospital stay (6.1 days vs. 12.6 days, p<0.001), and the need for narcotic analgesics in the postoperative period (34.6% vs. 80.0%, p<0.005) were better in laparoscopy group. Lymphadenectomy times were similar (56.6 minutes vs. 52.2 minutes, p=0.07). Sensitivities of computed tomography, magnetic resonance imaging, and positron emission tomography (PET) for the para-aortic lymphatic region were 20%, 25%, and 33.3%, respectively; specificities were 92.3%, 96.2%, and 100%, respectively. PET was found to have 100% positive predictive value for both pelvic and para-aortic lymphatic evaluations. Extraperitoneal laparoscopic lymphadenectomy was found to have lower morbidity as a minimally invasive procedure for locally advanced cervical cancer. Conclusions: Surgical staging is the gold standard for the retroperitoneal evaluation in cervical cancer. Laparoscopy appears to be a favorable option for surgical staging due to lower morbidity and faster recovery while maintaining comparable oncologic adequacy. PET was the most specific imaging modality.
