Advances Of Laparoscopic Retroperitoneal Lymph Node Dissection In Locally Advanced Cervical Cancer And Freliminary Clinical Study

Cervical cancer is the 4th common malignant tumor in women cancer.85% of cervical cancer occur in developing countries, and caused the highest mortality in cancer. NCCN guidelines of 2015 proposed that lymph node metastasis impact radiotherapy and prognosis in patients with locally advanced cervical cancer, locally advanced cervical cancer should be pelvic lymph node and the lymph node by the abdominal aorta. Laparoscopic is known as minimally invasive, clear vision, clear anatomical structure etc, and compared with the laparoscopic lymph node dissection through abdominal cavity, extraperitoneal lymph node resection was proved to have the advantages of better anatomical horizon, less abdominal organs disturbance, less blood loss, postoperative recovery fast. In recent years, domestic experts also constantly improve the operation, and the laparoscopic extraperitoneal and the lymph node resection of abdominal cavity. Our study is divided into two parts:1. A meta analysis of laparoscopic retroperitoneal/transperitoneal lymph nodes dessection in patients with gynecologic malignant tumor.2. Preliminary clinical study of laparoscopic retroperitoneal/transperitoneal lymph node dissection in patients with locally advanced cervical cancer. Clinical data are from guangxi medical university affiliated tumor hospital.Objective:Compare with the application of LRLD and LTLD in gynecological malignant tumors and make a meta-analysis, provide a based medicine evidence to operation methods. Methods:We searched LRLD and LTLD clinical data in gynecological malignant tumors applications from PubMed, MEDLINE, Cochrane library, EMBASE, CNKI database,and evidence-based analysis. RESULTS:Seven articles met the inclusion criteria, wherein the 325 cases of retroperitoneal group,344 cases of transperitoneal group. there was no significant difference in operative time, blood loss, number of lymph nodes resected, postoperative gastrointestinal recovery time. Conclusion:The current LRLD in gynecologic malignancies operative time, blood loss and postoperative recovery show no statistically significant difference from LTLD. However, due to the lack of large case still remains a lack of large-scale case study, side effects of radiotherapy, local and distant recurrence rate and long-term outcomes including survival and so on.Objective:To investigate the the feasibility and application of LRLD in LACC.Methods:41 cases in our hospital was diagnosed by pathology and FIGO staging of cervical cancer patients with stage IIB～VIA were divided into the LRLD group and the abdominal cavity group, we performed do laparoscopic abdominal aorta by abdominal cavity and peritoneal lymph nodes+pelvic lymph adenectomy. Results:21 cases LRLD group (1 case failed to establish pneumoperitoneum process), the abdominal cavity group 20 cases operation smoothly, including extraperitoneal group in the mean operation time (199.94±12.37) min, mean blood loss (55.20±10.52) ml, mean recovery time of gastrointestinal (13.54±2.35) h and urine tube (6.42 ±0.74) h function, and the time between surgery and radiotherapy (10.50 ±2.90) d has statistically significant difference lower than abdominal cavity group (P<0.05)Conclusions:LRLD has more advantages in the application of LACC than abdominal cavity group, compensate for the insufficient of imaging examination in diagnosis of cervical lymph node metastases.