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CLINICAL REVIEW: Patrick Petignat and Michel Roy Diagnosis and management of cervical cancer BMJ 2007; 335: 765-768 [Full text]

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Value of surgical staging in cervical cancer

Souhail ALOUINI   (15 October 2007)

Value of surgical staging in cervical cancer 15 October 2007
Souhail ALOUINI, gynaecological surgeon M.D, Ph.D. Department of Obstetrics and Gynaecology, Hôpital de Morlaix, 29600, France Send response to journal: Re: Value of surgical staging in cervical cancer	Dear Sir, Petignat and Roy report in their clinical review on the diagnosis and the management of cervical cancer that there is no consensus on the value of surgical staging (1). The pre-therapeutic staging of cervical cancer remains unclear: should it be clinical, depending on imaging techniques or surgical? Cervical cancer is staged by clinical examination according to FIGO. Nevertheless, this staging does not give information about the lymph node metastases. Indeed, the therapeutic choices are largely guided by the pelvic ± para aortic lymph node status in addition to the FIGO staging and the imaging techniques (2). It is widely recognised that lymph node metastasis is a major factor that correlates with a poor prognosis of cervical cancer (2). However, currently no clinical or imagery (magnetic resonance imaging, computed tomography, PET scan) examination enables to know with certainty if the lymph nodes are invaded or not (3). In a study concerning 84 patients with cervical cancer (FIGO stage I to IV) Martinz et al. related that the preoperative staging had been under- estimated in 87% of the cases (4). Only pelvic ± para-aortic lymph node sampling and its histological analysis allows us to know the node status of the patient. Ideally, the lymphadenectomy is carried out by laparoscopy . Moreover, the laparoscopy gives more information about the true extent of the tumour. It is a minimally invasive technique with a low morbidity when performed by experienced surgeons. In the case of lymph node metastasis an adjuvant chemotherapy could be proposed to the patient and may provide a survival benefit (2, 3). The lymphadenectomy has also a therapeutic effect; indeed, there is a significant relationship between the number of positive lymph nodes removed and disease-free survival (3, 4). Finally, the laparoscopic staging can be associated to a curative procedure such as radical vaginal trachelectomy for early stage or radical vaginal hysterectomy. In conclusion, the clinical and radiological examinations do not provide complete tumoural staging . Currently, the surgical staging is irrepleacable to precise the lymph node status of the patients with cervical cancer in order to propose the adequate treatment. References 1. Petignat P, Roy M. Diagnosis and management of cervical cancer. BMJ. 2007;335:765-8. 2. NCCN: Cervical Cancer. Practice Guidelines. in Oncology – v.1.2007. Guidelines Index. Cervical Cancer TOC. Staging, MS, References. www.nccn.org/professionals/physician_gls/PDF/cervical.pdf 3. Sakuragi N. Up-to-date management of lymph node metastasis and the role of tailored lymphadenectomy in cervical cancer. Int J Clin Oncol. 2007;12:165-75. 4. Marnitz S, Köhler C, Roth C, Füller J, Hinkelbein W, Schneider A.Is there a benefit of pre-treatment laparoscopic transperitoneal surgical staging in patients with advanced cervical cancer? Gynecol Oncol. 2005;99:536-44. Competing interests: None declared