Lymphadénectomie lombo-aortique extrapéritonéale et single-port dans les cancers du col localement avancés : faisabilité, reproductibilité, aspects ergonomiques et intérêt en termes de survie à l'ère de la tomographie par émission de positron (TEP) couplé au scanner (TDM)

Abstract : In locally advanced cervical cancer (LACC) the most important predictor of disease recurrence is para-aortic nodal status. The aim of our thesis was to evaluate the role of para-aortic lymphadenectomy (the current gold standard to assess para-aortic nodal status) in the era of positron emission tomography (PET) and single incision surgery (LESS). The published results of this thesis are: extraperitoneal para-aortic lymphadenectomy by LESS is feasible and we have described and codified the technique for the first time by a single left iliac incision; the technique we have developed is safe, reproducible and oncologically and ergonomically equivalent to conventional laparoscopy; para-aortic LAD staging is essential in LACC given the false negative rate of PET-CT found in this work (12% increasing to 22% if PET-CT reveals suspicious pelvic lymph nodes). We have also demonstrated, in the largest case series published to date, that para-aortic lymphadenectomy followed by chemoradiation including the pelvis and para-aortic lymph nodes for patients with micrometastatic para-aortic nodal involvement provides an overall survival that is identical to the overall survival of LACC with histologically negative para-aortic lymph nodes. However, in case of macrometastatic disease prognosis remains pejorative and requires other treatment options
Complete list of metadatas

Cited literature [167 references]  Display  Hide  Download

https://hal.univ-lorraine.fr/tel-01750213
Contributor : Thèses Ul <>
Submitted on : Thursday, March 29, 2018 - 12:40:39 PM
Last modification on : Tuesday, April 10, 2018 - 1:29:50 AM

File

DDOC_T_2013_0095_GOUY.pdf
Files produced by the author(s)

Identifiers

  • HAL Id : tel-01750213, version 1

Citation

Sébastien Gouy. Lymphadénectomie lombo-aortique extrapéritonéale et single-port dans les cancers du col localement avancés : faisabilité, reproductibilité, aspects ergonomiques et intérêt en termes de survie à l'ère de la tomographie par émission de positron (TEP) couplé au scanner (TDM). Médecine humaine et pathologie. Université de Lorraine, 2013. Français. ⟨NNT : 2013LORR0095⟩. ⟨tel-01750213⟩

Share

Metrics

Record views

43

Files downloads

109