Para-aortic and pelvic lymphadenectomy in locally advanced cervical cancer with pelvic lymph node metastasis

Wei Jiang ¹, Mei-Ling Zhong ¹, Su-Lan Wang ²

⁰Department of Gynecological Oncology, Jiangxi Maternal and Child Health Care Hospital, Nanchang, Jiangxi, 330008, China.

World Journal of Surgical Oncology +

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October 1, 2024

View abstract on PubMed

Summary

Para-aortic and pelvic lymphadenectomy before concurrent chemoradiation therapy (CCRT) is safe for locally advanced cervical cancer (LACC) patients with pelvic lymph node metastasis. This surgical staging improves survival in select patients with larger or multiple metastatic lymph nodes.

Area Of Science

Gynecologic Oncology
Surgical Oncology
Radiation Oncology

Background

Locally advanced cervical cancer (LACC) with pelvic lymph node (PLN) metastasis presents treatment challenges.
Accurate staging of lymph node involvement is critical for effective treatment planning in LACC.
Concurrent chemoradiation therapy (CCRT) is a standard treatment, but its effectiveness can be influenced by lymph node status.

Purpose Of The Study

To evaluate the efficiency of para-aortic and pelvic lymphadenectomy as a surgical staging tool in LACC patients with PLN metastasis.
To compare survival outcomes and treatment-related complications between patients undergoing surgical staging plus CCRT versus CCRT alone.

Main Methods

A cohort of 171 LACC patients with confirmed PLN metastasis was analyzed.
Patients were divided into two groups: surgical staging (para-aortic and pelvic lymphadenectomy + CCRT) and imaging staging (CCRT alone).
Progression-free survival (PFS), overall survival (OS), and complications were compared between the groups.

Main Results

No significant difference in PFS or OS was observed between the groups overall.
Subgroup analysis revealed significantly improved 5-year PFS (75.0% vs 41.5%) and OS (80.0% vs 50.1%) for surgical staging in patients with lymph nodes ≥1.5 cm.
Patients with two or more metastatic PLNs also showed significantly better PFS (69.2% vs 41.0%) and OS (73.1% vs 48.4%) with surgical staging.

Conclusions

Surgical staging prior to CCRT is safe and provides crucial lymph node details for LACC management.
This approach is particularly beneficial for patients with larger (≥1.5 cm) or multiple (≥2) metastatic pelvic lymph nodes.
Further investigation into surgical staging for select LACC patients is warranted.

Keywords:

Locally advanced cervical cancer Positive pelvic lymph node Surgical staging