RESECTION OF BULKY POSITIVE LYMPH-NODES IN PATIENTS WITH CERVICAL-CARCINOMA

From January 1987 to April 1992, 34 patients had resection of bulky po sitive lymph nodes, detected either at the time of radical hysterectom y (n=23) or by computed tomographic (CT) scan of the pelvis and abdome n prior to radiation therapy for more advanced cervical cancer (n=11). Following nodal resection, 33 patients received pelvic external beam radiation, 28 received pelvic and para-aortic radiation, and 23 receiv ed four cycles of cisplatin chemotherapy. The median number of resecte d positive nodes was 4, with a range of 1-44. All macroscopic nodal me tastases could be resected in each patient and morbidity was acceptabl y low. Positive nodes were confined to the pelvis in 17 patients, invo lved the common iliac group in nine patients, and involved the paraaor tic area in eight patients. With a mean follow-up of 36 months, 23 pat ients (67.6%) were alive, of whom 20 were free of disease. For patient s having a radical hysterectomy, actuarial 5-year survival was 80% for patients with disease involving pelvic and common iliac lymph nodes, and 48% for those with positive para-aortic nodes. Survival for patien ts with completely resected bulky pelvic and common iliac nodes was co mparable to that for patients with micrometastases. This study suggest s that every effort should be made to identify patients with cervical cancer who have bulky positive lymph node metastases, and to remove th ese nodes surgically prior to radiation therapy.