Role of Transperitoneal Laparoscopic Para-aortic Lymph Node Dissection for the Treatment of Elderly Patients with Locally Advanced Squamous Cell Carcinoma of the Uterine Cervix

Summary Background Surgical staging using transperitoneal laparoscopic para-aortic lymph node dissection is an option for the pretreatment evaluation of locally advanced cervical cancer; however, its role for elderly patients (≥ 65 years) remains unclear. Methods Elderly patients with stage IIB–IVA cervical squamous cell carcinoma who underwent transperitoneal laparoscopic para-aortic lymph node dissection (TLSPAD) before radiation therapy (RT) or concurrent chemoradiation therapy (CCRT) during 1993–2001 were included in this retrospective study. The control group included elderly patients with the same clinical conditions, except they did not undergo TLSPAD. Survival and major bowel complications were compared between these two groups. Results The TLSPAD group consisted of 19 patients (median age: 72 years; range: 65–78 years), and the control group consisted of 37 patients (median age: 73 years; range: 65–86 years). In the TLSPAD group, para-aortic lymph node metastasis was noted in 15.8% of patients and another 15.8% were unable to have their lymph node laparoscopically retrieved. Although patients in the TLSPAD group demonstrated a higher rate of receiving CCRT than the control group, neither failure-free survival nor overall survival were statistically different between these two groups. Subsequent major bowel complications (e.g., fistula, bowel obstruction) were more frequent in the TLSPAD group (36.8%) than the control group (10.8%; p =0.032). Conclusion In elderly patients with locally advanced cervical squamous cell carcinoma, pretreatment TLSPAD might not improve survival and might be associated with an increased risk of subsequent major bowel complications. Extraperitoneal laparoscopic para-aortic lymphadenectomy might be a better method for the pretreatment surgical staging of elderly patients because it could potentially result in fewer bowel complications.