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Objectives:To introduce the technique of laparoscopic complete dissection of para-aortic lymph nodes up to renal vein level, high level with easy performing and approaching position during laparoscopic operation in patients with gynecologic malignancies.Methods:From March, 2014 to September 2017, The forty-nine patients with gynecologic malignancies (endometrial and ovarian malignancy), who required a laparoscopic staging operation or laparoscopic cytoreductive surgery of metastatic nodules on para-aortic area suspected by abdomino-pelvic computed tomography (AP-CT) and Positron emission tomographyu2013computed tomography (PET-CT). The data was analyzed retrospectively with medical records. All laparoscopic PALND was performed up to renal vein level through 5-ports laparoscopic approach by a single surgeon (Y.S K).Results Laparoscopic complete dissection of para-aortic lymph node up to level of renal vein (PALND) were performed in 14 patients with endometrial cancer and 35 patients with ovarian cancer. The mean operation time of PALND was 31.5 u00b14.6 minutes. The mean number of dissected para-aortic lymph nodes was 9.6 u00b1 2.7 proven by pathologic reports. There were only 2 cases of conversion to laparotomy, which included one of left renal vein injury and one of left gonadal vein. The two cases occurred at early time of running 5-ports laparoscopic PALND up to renal vein. The two cases of laparotomic conversion due to vessel injury was cured by the assistant a vascular surgeon.Conclusions:If it is indicated for PALND in gynecologic malignancies, laparoscopic 5-ports approach of PALND up to level of renal vein is fine approaching technique with reasonable operation time.

Objectives:The aim of this study is to investigate therapeutic benefits of neoadjuvant chemotherapy and survival outcomes in patients with locally advanced cervical cancer (LACC) after neoadjuvant chemotherapy(NACT) followed by radical surgery with or without postoperative adjuvant treatment.Methods:This study was retrospectively analyzed forty-seven patients who had LACC IB2-IIB were eligible for radical surgery NACT, between June 2005 and October 2015. The regimen of neoadjuvant chemotherapy was divided into three groups. Group 1 was paclitaxel with platinum, Group 2 was mitomycin, vincristine and platinum, and Group 3 was other regimens. Radical operability and response rate of NACT was analyzed and a survival outcome in patients with LACC with neoadjuvant chemotherapy followed by radical operation was analyzed according to regimen of NACT.ResultsGroup 1 was eleven, Group 2 was twenty-one, and Group 3 was fifteen patients. The maximal diameter of tumor on MRI before neoadjuvant chemotherapy was 4.78 cm (2.8-8.0, SD=1.19). The response rate of NACT is high in Group 2, 50.52% compared with 25.61% in group 3. All patients received radical operation via laparoscopy (76.4%) or laparotomy (23.4%) after neoadjuvant chemotherapy. The mean follow-up period was 49.6 months, SD=2.69. The recurrence rate was 38.3% (18/47). Five-year survival rate was 72.1 % and overall survival in Group 2 was 84.9 months (Log-rank p value= 0.003)Conclusions:Despite of limitation of small number and retrospective study, our study suggests that NACT with MVP regimen in patients with LACC could be a good therapeutic option for radical operation and better survival outcome.