Pretreatment surgical staging in cervical carcinoma: therapeutic efficacy of pelvic lymph node resection

Pretreatment surgical staging in cervical carcinoma has been studied extensively to define a group for extended field radiation or adjuvant chemotherapy. A theoretical, but as yet unproved, benefit from this surgery is the resection of large, presumably radioresistant, pelvic nodal metastases before radiation therapy. One hundred fifty-six patients were divided by pelvic nodal status after surgical staging with excision of pelvic lymph nodes: group A, negative (n = 81); group B, microscopic metastases only (n = 18); group C, macroscopic nodal metastases resected (n = 48); and group D, unresectable nodal metastases (n = 9). The 5-year recurrence-free survival in group C (51%) approached that of group B (57%) and was significantly better than that of group D (0%). The groups are compared by International Federation of Gynecology and Obstetrics stage, grade, histology, and incidence of paraaortic metastases. Patterns of recurrence imply improved pelvic control in patients undergoing resection of pelvic nodal metastases. Surgical removal of pelvic nodal metastases before radiation therapy is recommended.