The case for completing the lymphadenectomy when positive lymph nodes are found during radical hysterectomy for cervical carcinoma

Background. In the present study we report on the results of a retrospectiv e study on the effect on survival of the pelvic lymphadenectomy in a group of 294 patients with stage Ia2-IIa cervical carcinoma treated by radical hy sterectomy from 1984 through 1996 at the Leiden University Medical Center. Methods. Lymphadenectomy was called 'complete' when lymph node bearing tiss ue had been removed from 5 or 6 lymph node stations and 'not-complete' when this was the casein 1-4 stations. Results. A radical hysterectomy was carried out in 294 patients. In 63 pati ents positive lymph nodes were found. Patients with positive nodes showed p oorer 5 year survival: 64.5% compared to 90% in patients with negative node s. In the univariate analysis the following factors were found to affect th e presence of node metastases in a statistically significant way: age, tumo r size, depth of infiltration, vase-invasion, surgical margins, parametrial infiltration, stage and place of referral. In 63 patients with positive no des, a complete lymphadenectomy was carried out in 23 patients, and in 40 p atients the procedure was incomplete. All 63 patients were treated by adjuv ant radiation therapy; those with complete lymphadenectomy had significantl y less recurrences (25%) compared to those with incomplete lymphadenectomy (56%): the relative risk (RR) was 2.9 (95%. ci: 1.3-6.7), p = 0.012. After adjustment for other prognostic factors including tumor size, depth of infi ltration and parametrial involvement, the complete lymphadenectomy showed a n independent effect on disease free survival: RR = 3.2 (95% ci:1.3-7.7), p =0.011. Prognostic factors were not significantly different for patients wi th complete or incomplete lymphadenectomy. Conclusions. From the results of this study, although retrospective and non randomized, it can be concluded that to complete removal of lymph nodes in combination with radical hysterectomy seems to have a beneficial effect on prognosis in case of positive nodes; The policy of aborting the procedure when lymph node metastases are found in frozen section should be questioned .