Is there a place for a less extensive radical surgery in locally advanced cervical cancer patients?

Objective. The aim of this study was to assess the association among the pa thological status of different lymph node groups and parametrium in a singl e institutional population of 103 locally advanced cervical cancer (LACC) c ases who underwent surgery after a neoadjuvant approach. A series of 29 ear ly cervical cancer patients was also included in the analysis. Methods. Eighty-two LACC patients with documented clinical response to neoa djuvant treatment and 29 early stage cases underwent radical surgery. The o perative technique consisted of a type II-V radical hysterectomy and system atic pelvic lymphadenectomy (median number of lymph nodes removed 46; range 5-140). Sixty-four cases were submitted to para-aortic lymphadenectomy up to the level of the inferior mesenteric artery (median number of lymph node s removed 13; range 1-37). Results. Two subgroups of lymphnodes were defined: lower pelvic lymphnodes (LPN), including obturator and external iliac nodes, and upper pelvic nodes (UPN) including common iliac, presacral, and internal iliac nodes. Metasta tic UPN involvement showed a strict association with LPN involvement: in LA CC cases, 6 of 7 (86%) positive UPN cases had tumor disease at the LPN leve l. The single positive UPN case with negative LPN was intraoperatively iden tified by palpation and frozen section. Similarly, in early cervical cancer patients, 100% of positive UPN cases showed metastatic involvement at the LPN level. Sixty-three of 70 (90%) LACC patients with negative histological parametrium had negative LPN. Among 12 cases with metastatic involvement o f parametrium, 5 cases (41.7%) had positive LPN. In early stage cervical ca ncer, 23 of 27 (85%) cases with negative parametrium showed no lymph nodal involvement. Intraoperative palpation of the parametrium could identify all cases with parametrial involvement not predicted by LPN status. Conclusions. These data offer the basis for tailoring the extent of radical surgery in LACC patients, through the selection of those lymph node statio ns likely to provide reliable information on the pathological status of UPN and parametrium. (C) 2001 Academic Press.