Radical hysterectomy for cervical cancer: hysterectomy before pelvic lymphadenectomy or vice versa?

The technique for radical abdominal hysterectomy (RAH) and lymphadenectomy (LND) for patients with cervical cancer has been well described. Whether RA H should be performed before or after pelvic lymph node dissection (PLND) i s a controversial issue. This study compared the two procedures performed a t the same institution. Patients treated with type III RAH for cervical can cer stage IB-IIA at our institution between 1987 and 1995 were included in this study. Only patients who underwent para-aortic lymph node dissection ( PALND) first, followed by PLND and then RAH (Group A) or RAH and then PLND (Group B) were included. Clinical and surgical information including intrao perative and postoperative complications was collected. Operative reports w ere used to identify the patients who had RAH performed before PI;ND or vic e versa. Data analysis was obtained using unpaired t-test with significance set at P < 0.05. Complete information was obtained for 314 patients. The r esults of Group A (157 patients) and Group B (157 patients) were as follows : mean age = 45.3 and 44.8 (P = 0.73); mean weight = 149 and 149 Ib.; mean length of stay = 10 and 8 days (P < 0.0001); mean operative time = 230 and 172 mins (P = 0.004); mean estimated blood loss (EBL) = 1,238 and 1098 cc ( P = 0.21); mean number of PALN removed = 7 and 6 (P = 0.06); mean number of PLN removed = 28 and 26 (P = 0.24). No statistical difference in major int raoperative and postoperative complications was observed. The most common c omplication was postoperative fever (53/157 in Group A and 49/157 in Group B). Radical hysterectomy can be safely performed either before or after PLN D. The number of pelvic lymph nodes removed, as well as the EEL and the int raoperative complications are similar and are not affected by the operative time. The surgeon should decide the sequence of the procedures accordingly to his/her personal preference.