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.