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.
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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