Para-Aortic Lymph Node Staging and Oncologic Outcomes in Locally Advanced Cervical Cancer: A Narrative Review

Area of Science:

• Gynecologic Oncology
• Radiation Oncology
• Surgical Oncology

Background:

• Para-aortic lymph node involvement is a critical prognostic factor in locally advanced cervical cancer (LACC), affecting 17-24% of patients.
• Current guidelines offer divergent approaches: imaging-based staging (FIGO, ESGO) versus pre-treatment para-aortic lymphadenectomy (NCCN).

Purpose of the Study:

• To critically evaluate the oncologic impact, specifically progression-free and overall survival, of surgical versus imaging-based para-aortic staging in LACC.
• To synthesize evidence comparing pre-treatment surgical staging with clinical imaging-based staging in women with LACC.

Main Methods:

• Comprehensive literature search of MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, and Scopus up to January 2026.
• Inclusion of comparative studies on LACC (FIGO stages IB2-IVA or IB3-IVA) undergoing definitive radiotherapy, comparing surgical and imaging staging arms.
• Narrative review methodology adhering to SANRA quality criteria.

Main Results:

• Twelve studies (2 RCTs, 10 observational) were included.
• Surgical staging increased detection of occult para-aortic disease and led to more frequent extended-field radiotherapy (18-44%).
• No reproducible survival advantage (progression-free or overall) was observed with surgical staging compared to imaging-guided chemoradiation.

Conclusions:

• Pre-treatment surgical para-aortic staging provides enhanced anatomic and prognostic information in LACC but lacks consistent survival benefits over imaging-based staging with modern chemoradiation.
• Current evidence does not support routine surgical staging; its use requires further prospective evaluation in large clinical trials.
• Surgical staging may be considered an individualized option for highly selected cases within multidisciplinary teams at experienced centers.