SURGICAL PREDICTORS OF PARAAORTIC METASTASES IN EARLY-STAGE CERVICAL-CARCINOMA

Radical pelvic surgery for cervical carcinoma is contraindicated in th e presence of para-aortic node metastases. However, the incidence of p ara-aortic nodal involvement is very low in early-stage disease, There fore, it may not be necessary to subject all patients to para-aortic l ymphadenectomy prior to radical hysterectomy, Medical records for 408 patients with early-stage cervical carcinoma treated at the Pennsylvan ia State University-M, S. Hershey Medical Center were reviewed to asce rtain if clinical factors can be utilized intraoperatively to accurate ly predict those patients at minimal risk for para-aortic lymph node m etastases, The presence of clinically suspicious (abnormally enlarged or firm) pelvic or para-aortic lymph nodes or extracervical spread of tumor at the time of exploration were significant predictors of para-a ortic metastases (P < 0.001). The majority of patients (85%) had none of these risk factors, and no patient had para-aortic metatases in the absence of these predictors. Suspicious pelvic or para-aortic lymph n odes were present in the minority of patients (15%) and identified all patients with para-aortic metastases. Therefore, paraaortic lymphaden ectomy may be safely omitted at the time of exploration for radical hy sterectomy in the absence of enlarged or abnormally firm pelvic or par a-aortic lymph nodes, In the presence of either of these factors or ex tracervical spread of disease a paraaortic lymphadenectomy is necessar y to rule out metastases. (C) 1995 Academic Press, Inc.