Introduction/Background The surgical pretherapeutic staging of para-aortic (PA) lymph nodes in locally advanced cervical cancers (LACC) was historically limited to the left renal vein cranially. Given the low rate of isolated skip metastasis above the IMA, the potential surgical morbidity and the absence of evidence regarding the survival benefits of the supramesenteric dissection, a study was conducted to compare inframesenteric (IM-PALND) and infrarenal (IR-PALND) PA lymphadenectomy for patients with LACC. The long-term survival outcomes of these patients are presented hereunder.
Methodology A prospective cohort of IM-PALND was compared with a retrospective series of patients with IR-PALND in a single referral center, from 2011 to 2015. All patients had a negative pretherapeutic imaging (MRI and PET/CT) at the PA level. The therapeutic sequence included an extraperitoneal laparoscopic PALND, concomitant chemoradiation and uterovaginal brachytherapy, followed or not by surgery, for primary or recurrent LACC.
Results 119 patients were included: 55 in the IM-PALND group, and 64 in the IR-PALND group. The populations were comparable in terms of comorbidities, histology, and FIGO stage. Nodal PA status were similar for both groups. The median follow-up was 65 months. At 5 years, overall survival (58.6% versus 69.8%, p=0.49), recurrence-free survival (57.1% versus 55.3%, p=0.90), distant metastasis-free survival (56.9% versus 58.5%, p=0.69) and paraaortic recurrence-free survival (58.5% versus 66.5%, p=0.50) were not significantly different between IM-PALND and IR-PALND, respectively.
Conclusion This is the first report on comparative long-term survival outcomes between IM-PALND and IR-PALND for the pretherapeutic staging of LACC. Long-term survival outcomes were not significantly different between IM-PALND and IR-PALND.
Disclosure Nothing to disclose.
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