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2022-RA-368-ESGO Potential role of para-aortic lymph nodes dissection in early-stage cervical cancer
  1. Irene Iavarone,
  2. Raffaela Maria Carotenuto,
  3. Maria Cristina Solazzo,
  4. Marco La Verde and
  5. Carlo Ronsini
  1. Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania ‘Luigi Vanvitelli’, Naples, Italy


Introduction/Background Standard treatment for early-stage cervical cancer patients is radical hysterectomy (RH) with pelvic lymphadenectomy. Even in the absence of pelvic lymph nodes involvement, para-aortic lymph nodes (PAN) may include the first draining nodal metastasis, setting survival rates at 20–45%. Primary aim of our review was to investigate whether PAN sampling has an impact on metastases detection and/or disease recurrence in early-stage cervical cancer.

Methodology We systematically explored 4 search engines to establish eligible studies: PubMed, EMBASE, Scopus, and Cochrane Library. We adopted the following string of idioms: ‘Uterine Cervical Neoplasms’[Mesh ]) AND ‘Lymph Node Excision’[ Mesh] early-stage AND para-aortic. We focused on patients with IB1-to-IIA1 stages of cervical cancer who underwent PAN sampling.

Results According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), full-text studies assessed for eligibility were 9 (Table 1). Matsuo et al. demonstrate that early-stage cervical cancer is associated with PAN positivity in 1.2% of patients (p < 0.001) and with recurrence of disease in 2.7% of patients (p < 0.001) in 62.2 months on average. In Li et al. prospective trial, neither patient with stage I developed PAN positivity nor para-aortic recurrence, with an overall recurrence-free survival rate of 100% during a median follow-up (FU) of 38 months. On the contrary, Barquet-Muñoz et al. identified more elevated rates of PAN positivity (35%) and disease recurrence (35%) in a median FU time of 32.2 months. Those data positively correlate with stage of disease (p < 0.001). Ouldamer et al. do not specify if the 117 with positive PAN over 510 were affected by early-stage cervical cancer. In Lea et al. study, 4.3% of patients had PAN metastases, and 2.8% showed recurrence.

Abstract 2022-RA-368-ESGO Table 1

Characteristics of incuded studies

Abstract 2022-RA-368-ESGO Table 2


Conclusion PAN dissection in early-stage cervical cancer should be assessed according to intraoperative detection to identify patients at risk who may benefit from para-aortic lymphadenectomy.

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