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Pelvic Lymphadenectomy Improves Survival in Patients With Cervical Cancer With Low-Volume Disease in the Sentinel Node: A Retrospective Multicenter Cohort Study
  1. Afra Zaal, MD*,
  2. Ronald P. Zweemer, MD, PhD*,
  3. Michal Zikán, MD, PhD,
  4. Ladislav Dusek, MD, PhD,
  5. Denis Querleu, MD, PhD§,
  6. Fabrice Lécuru, MD, PhD,
  7. Anne-Sophie Bats, MD, PhD,
  8. Robert Jach, MD,
  9. Libor Sevcik, MD#,
  10. Petar Graf, MD, PhD#,
  11. Jaroslav Klát, MD#,
  12. Grzegorz Dyduch, MD, PhD,
  13. Silvia von Mensdorff-Pouilly, MD, PhD**,
  14. Gemma G. Kenter, MD, PhD**,
  15. René H.M. Verheijen, MD, PhD* and
  16. David Cibula, MD, PhD
  1. *Division of Woman and Baby, Department of Gynaecological Oncology, University Medical Center Utrecht, Utrecht, The Netherlands;
  2. Department of Obstetrics and Gynecology, Gynecological Oncology Centre, First Faculty of Medicine and General University Hospital, Charles University, Prague;
  3. Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic;
  4. §Institut Claudius Regaud, Toulouse;
  5. Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, European Georges-Pompidou Teaching Hospital, Paris, France;
  6. Jagiellonian University Medical College, Krakow, Poland;
  7. #University Hospital Ostrava, Ostrava, Czech Republic; and
  8. **Center for Gynaecologic Oncology Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
  1. Address correspondence and reprint requests to Afra Zaal, MD, Division of Woman and Baby, Department of Gynaecological Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. E-mail: a.zaal{at}


Objective In this study, we aimed to describe the value of pelvic lymph node dissection (LND) after sentinel lymph node (SN) biopsy in early-stage cervical cancer.

Methods We performed a retrospective multicenter cohort study in 8 gynecological oncology departments. In total, 645 women with International Federation of Gynecology and Obstetrics stage IA to IIB cervical cancer of squamous, adeno, or adenosquamous histologic type who underwent SN biopsy followed by pelvic LND were enrolled in this study. Radioisotope tracers and blue dye were used to localize the sentinel node, and pathologic ultrastaging was performed.

Results Among the patients with low-volume disease (micrometastases and isolated tumor cells) in the sentinel node, the overall survival was significantly better (P = 0.046) if more than 16 non-SNs were removed. No such significant difference in survival was detected in patients with negative or macrometastatic sentinel nodes.

Conclusions Our findings indicate that in patients with negative or macrometastatic disease in the sentinel nodes, an additional LND did not alter survival. Conversely, our data suggest that the survival of patients with low-volume disease is improved when more than 16 additional lymph nodes are removed. If in a prospective trial our data are confirmed, we would suggest a 2-stage operation.

  • Uterine cervical cancer
  • Lymph node metastasis
  • Micrometastasis
  • Isolated tumor cells
  • Low-volume disease
  • Sentinel lymph node
  • Lymph node dissection
  • Survival

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  • The authors declare no conflicts of interest.