Role of pelvic and para-aortic lymphadenectomy in abandoned radical hysterectomy in cervical cancer

Abstract

Background: Cervical cancer (CC) occupies fourth place in cancer incidence and mortality worldwide in women, with 560,505 new cases and 284,923 deaths per year. Approximately, nine of every ten (87%) take place in developing countries. When a macroscopic nodal involvement is discovered during a radical hysterectomy (RH), there is controversy in the literature between resect macroscopic lymph node compromise or abandonment of the surgery and sending the patient for standard chemo-radiotherapy treatment. The objective of this study is to compare the prognosis of patients with CC whom RH was abandoned and bilateral pelvic lymphadenectomy and para-aortic lymphadenectomy was performed with that of patients who were only biopsied or with removal of a suspicious lymph node, treated with concomitant radiotherapy/chemotherapy in the standard manner.

Methods: A descriptive and retrospective study was conducted in two institutions from Mexico and Colombia. Clinical records of patients with early-stage CC programmed for RH with an intraoperative finding of pelvic lymph, para-aortic nodes, or any extracervical involvement that contraindicates the continuation of surgery were obtained. Between January 2007 and December 2012, 42 clinical patients complied with study inclusion criteria and were selected for analysis.

Results: In patients with CC whom RH was abandoned due to lymph node affectation, there is no difference in overall survival or in disease-free period between systematic lymphadenectomy and tumor removal or lymph node biopsy, in pelvic lymph nodes as well as in para-aortic lymph nodes, when these patients receive adjuvant treatment with concomitant radiotherapy/chemotherapy.

Conclusions: This is a hypothesis-generator study; thus, the recommendation is made to conduct randomized prospective studies to procure better knowledge on the impact of bilateral pelvic and para-aortic lymphadenectomy on this group of patients.

Keywords: Abandoned radical hysterectomy; Cervical cancer; Systematic lymphadenectomy.

Fig. 1

Overall survival (OS) in patients with pelvic lymph node procedure. Five-year OS in the LNB group was 55.5%, and in the BPL group 90.9% (p = 0.171)

Fig. 2

Disease-free survival (DFS) in patients with pelvic lymph node procedure. Five-year DFS in the LNB group was 52%, and in the BPL group 60% (p = 0.265)

Fig. 3

Overall survival (OS) in patients with para-aortic lymph node procedure. Five-year OS in the LNB group was 42.1%, and in the PAL group 100% (p = 0.126)

Fig. 4

Disease-free survival (DFS) in patients with para-aortic lymph node procedure. Five-year DFS in the LNB group was 32.5%, and in the PAL group 80% (p = 0.437)