Laparoscopic para-aortic and pelvic lymphadenectomy and radical hysterectomy in a patient with cervical cancer, six months after primary chemoradiation

Treatment of Stage IB-IIA cervical carcinoma is controversial. The choice to perform surgery or chemoradiation depends on the FIGO Stage, which does not include evaluation of lymph node involvement, although the prognosis of the patients depends on this evaluation. There is no method however, to safely evaluate preoperative lymph nodes metastasis, as both magnetic resonance imaging (MRI) and computed tomography (CT) have poor sensitivity and high specificity. As a result, inaccurate preoperative lymph node assessment can lead to suboptimal treatment. The authors report the case of a 42-year-old patient with cervical cancer Stage IB2, who was primary treated with chemoradiation. Although at the time of diagnosis no lymph node metastasis was detected, six months after treatment, an enlarged five-cm lymph node was found in the area of left iliac vein. The patient underwent laparoscopic pelvic and para-aortic lymphadenectomy and nerve sparing radical hysterectomy. Pathologic examination revealed one positive lymph node out of the 41 removed and no cancer cells in the uteral structures. There are cases of cervical cancer in which chemoradiation seems to be insufficient. Laparoscopic nerve-sparing radical hysterectomy can be the treatment in patients with lymph node metastasis after primary chemoradiation. It offers oncological safety combining the advantages of laparoscopy and the nerve-sparing technique. Furthermore, adjuvant chemotherapy or radiation can be initiated immediately, offering the best therapeutical choice in the authors' opinion.