The Studies Of System Review,Clinical Research In The Laparoscopic Extraperitoneal Para-Aortic Lymphadenectomy In Locally Advanced Cervical Cancer

In women, cervix cancer, one of the most common cancer in developing regions, according to the statistics of WHO, More than80%of cases occur in developing countries, and approximately80%are advanced at diagnosis. At present, ovarian and endometrial cancer have been using the surgical staging,while cervical cancer still using the FIGO staging, which does not consider the prognosis affected by lymph node. Differences between Clinical staging and surgical staging have been reported by many reports. The characteristic of laparoscopy is of amplification, clear vision, easy to identify anatomical location and so on. With the popularity of laparoscopic techniques, effective and safety of surgical staging have been confirmed. In the choice of surgical approach, laparoscopic extraperitoneal lymphadenectomy for the first time to be carried out in1996, it combined the advantages of laparoscopic and retroperitoneal route, reducing the risk of intestinal injury and adhesion, shorten the time of hospitalization, and to bring great help to improve the quality of life of patients. The foreigner tumor experts constantly make improvements to this technology, and the feasibility and safety of laparoscopic retroperitoneal approach were explored. There are few studies in domestic. This study is divided into two parts:(1). System review of safety and feasibility of laparoscopic extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer.(2). Preliminary clinical studies of laparoscopic extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer. Data were obtained from Department of gynecological oncology, Affiliated Cancer Hospital of Guangxi Medical University. Objective To conduct a system review of the literature for the treatment of laparoscopic retroperitoneal lymphadenectomy in locally advanced cervical cancer and provides evidence of the existing literature. Method To retrieve a laparoscopic retroperitoneal lymphadenectomy for CBM, CENTRAL MEDLINE, Cochrane library, EMBASE, CNKI database (Laparoscopic retroperitoneal lymph node dissection LRLD) in locally advanced cervical cancer (LACC) with clinical data, or relevant literature analysis, to explore the safety, feasibility and clinical significance to the application of LRLD in LACC. Results12studies met the inclusion criteria,2RCT included,10descriptive studies included. Cervical cancer subgroup of patients enrolled in727cases, retroperitoneal group695Cases,32cases of transperitoneal group. From the surgical procedure, surgical effect, postoperative recovery, recurrence and long-term prognosis to explore the safety and feasibility of the advanced laparoscopic retroperitoneal lymphadenectomy in locally advanced cervical cancer, to provides evidence of beneficial for the treatment of laparoscopic retroperitoneal lymphadenectomy in locally advanced cervical cancer. Conclusion Laparoscopic retroperitoneal lymphadenectomy surgical is of small incision, postoperative intestinal function recovery fast, diets fast recovery, and advantages of short hospitalization time. But the study of RCT multi center still lack of large-scale case study of RCT multi center, local and distant recurrence rate and long-term prognosis include5year survival is still lack of large-scale case. Object To study the safety, feasibility and technique of laparoscopic retroperitoneal in locally advanced cervical cancer. Methods13patients of the Affiliated Tumor Hospital of Guangxi Medical University from March,2013to March,2014were treated by Pathologically confirmed locally advanced cervical cancer (IIB-IVA) to carry out laparoscopic retroperitoneal lymph node dissection. The feasibility of the data were analyzed. Results1cases of operation in the process of the separation of peritoneal rupture, CO2leak into the abdominal cavity, The peritoneal cavity pressure outside can not be maintained, then changes to intraperitoneal surgery. The other12cases of laparoscopic extraperitoneal lymphadenectomy successfully, the median time of operation was230minutes (130-359minutes), the median blood loss was50(20-350) ml. The total number of lymph nodes removed was336,10(5-17) para aortic lymph nodes, and18(16-40) pelvic lymph nodes.11(91.7%) patients with lymph node metastasis. The temperature dropped to normal after adequate drainage of Lymphocyst disappeared. Followed up for1-12months, no recurrence or metastasis. Conclusions LRLD technically is feasible, safe, less pain, small incision, quicker recovery, shorter hospitalization and less blood loss, while reducing the tumor provides a basis for determining the field with subsequent radiotherapy. The low rate of postoperative complications can make the daily life of the patients recover rapidly, to subsequent adjuvant therapy in advance and to improve the quality of life.