Impact of surgical staging in women with locally advanced cervical cancer

Objective. The aim of this study was to evaluate the impact of surgical sta ging in the treatment and outcome of women with Locally advanced cervical c ancer. Methods, Ninety-eight women with locally advanced cervical cancer treated b etween 1993 and 1997 were retrospectively reviewed. Survival probabilities were calculated by the Kaplan-Meier product limit method and compared with the log-rank test. Results. Of the 98 women treated over the 5-year period, 86 were surgically staged: 61 by a retroperitoneal approach, 18 by larparoscopy, and 7 by lap arotomy. Median blood loss was 120 cc and median length of hospitalization was 3 days. Preoperative CT scans (n = 55), when compared with surgical fin dings, missed macroscopic nodal disease in 20% and microscopic disease in 1 5% and overcalled disease in 10% of cases. Lymph node metastases were found in 45/86 patients (52%): 12 microscopic and 33 macroscopic. The highest le vel of nodes found to be involved was pelvic in 23, common iliac nodes in 3 , para-aortic nodes in 14, and scalene nodes in 5 cases. Of the 86 patients , 49 received pelvic radiation, 27 received extended field radiation, and 1 0 were identified for palliative treatment only (5 scalene node metastasis, 5 extensive intraperitoneal disease). For node-negative patients, 5-year s urvival was 74%; for microscopic nodal involvement it was 58%; and for macr oscopic involvement it was 39% (P = 0.007). Five-year survival for women wi th para-aortic node involvement was 52%. Number of nodes involved was a sig nificant prognostic variable (P = 0.008). Patients who received chemotherap y had a 5-year survival of 68% compared to 35% for those who did not (P = 0 .06). Factors which did not affect survival included age, histology, type o f surgery, stage, and type of radiation (pelvic vs extended). Conclusion. Surgical staging of women with locally advanced cervical cancer can be performed with acceptable morbidity and it provided more accurate i nformation than CT scans and resulted in a modification of the standard pel vic radiation field for 43% of our patients. The information obtained from surgical staging allows better individualization of therapy, which may impr ove overall clinical outcome. a (C) 1999 Academic Press.