Para-aortic lymph node metastases in locally advanced cervical cancer: Comparison between surgical staging and imaging

• Published in: Gynecologic oncology 2015-08, Vol.138 (2), p.299-303
• Main Authors: Vandeperre, Armin, Van Limbergen, Erik, Leunen, Karin, Moerman, Philippe, Amant, Frédéric, Vergote, Ignace
• Format: Article
• Language: English
• Subjects: Adult; Aorta; Cervical cancer; Female; Hematology, Oncology and Palliative Medicine; Humans; Lymph Node Excision; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymph Nodes - surgery; Lymphatic Metastasis; Middle Aged; Multimodal Imaging; Neoplasm Staging; Obstetrics and Gynecology; Para-aortic lymphadenectomy; PET/CT; Positron-Emission Tomography; Retrospective Studies; Staging; Tomography, X-Ray Computed; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - diagnostic imaging; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; Young Adult
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2015.05.021

Abstract Objective Compare surgical staging with imaging (PET-CT, PET or CT) of the para-aortic lymph nodes (PAOLN) in locally advanced cervical cancer (LACC). Methods Monocentric retrospective study of 336 patients with cervical cancer FIGO stage IB2-IVA. All patients underwent staging of the PAOLN using imaging by PET-CT, PET or CT. Two hundred and four patients with normal or not overtly malignant PAOLN on imaging underwent surgical PAOLN staging up to the inferior mesenteric artery (189 endoscopy and 15 laparotomy). Results The patients were divided into 4 groups: 16 with positive surgical staging and negative PAOLN imaging (sPAOLN +), 172 negative surgical staging (sPAOLN −), 20 positive imaging without surgical staging (iPAOLN +) and 128 negative imaging without surgical staging (iPAOLN −). Median operative time of staging was 70 (40–160) min and median number of removed PAOLN was 5 (0–24). Operative complications were 10 peroperative bleedings, 2 ureteral traumas, 1 carbon dioxide retention and 1 retroperitoneal abscess. The median follow-up was 31 (1–218) months. Overall survival at 2 years was for sPAOLN +, sPAOLN −, iPAOLN +, and iPAOLN − 40%, 83%, 58%, and 69%, respectively (p < 0.001 for sPAOLN + and iPAOLN + versus sPAOLN − and iPAOLN −). The most frequent site of recurrence was distant LN metastases (outside the pelvic and PAO area) (36%) for sPAOLN +. For sPAOLN −, iPAOLN +, and iPAOLN − the most frequent site of recurrence was the cervix (27%, 66% and 26%, respectively). Conclusion Despite negative imaging, PAOLN metastases were present in 8% at surgical staging. Overall survival is significantly influenced by the presence of PAOLN metastases.