Re-consideration of lymphadenectomy for stage Ib1 cervical cancer

Because of less frequent lymph node metastasis and parametrial involvement, patients with stage Ib1 cervical cancer may benefit from a curtailment of surgery. We retrospectively investigated the distribution of lymph node metastasis in stage Ib1 patients. After comparing the data with that of higher stages and sentinel lymph node navigation (SLNN), the appropriate extent of lymphadenectomy (LA) in stage Ib1 disease was newly suggested.

A total of 303 patients underwent a radical hysterectomy with LA and the region-specific rate of node metastasis was obtained. SLNN was performed for 50 patients using (99m) Tc phytate injection into the cervix and intra-operative detection by a gamma-probe.

The rate of node metastasis and the average number of nodes removed, respectively, were: 23/189 (12.2%), 65.2 in stage Ib1; 14/47 (29.8%), 70.1 in stage Ib2; 7/20 (35.0%), 78.2 in stage IIa; and 26/47 (55.3%), 69.1 in stage IIb. Lymph node metastasis in stage Ib1 was prevalent in the obturator (Ob) (9.5%), inter-iliac (Ii) (4.9%), superficial common iliac (Sc) (2.3%), cardinal (Cd) (2.2%) and external iliac (Ei) (1.7%) nodes. In patients with upper stage disease, lymph node metastasis could occur in all lymph nodes. In stage Ib1 patients, the sentinel nodes were assigned only to the Ob, Ii, Sc and Ei nodes, being identical with frequent metastatic sites in stage Ib1 (excluding Cd).

The extent of LA can be routinely completed with the removal of Ob, Ii, Ei, Sc and Cd nodes, which may provide a higher quality of life, including the reduction of lymphedema by preventing the removal of the inguinal nodes.