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Abstract
Introduction/Background The PAROLA trial will define outcomes of paraortic lymph node dissectionPALND for staging purposes versus imaging only in the management of patients with locally advanced cervical cancerLACC. Meanwhile, according to guidelines, referral centers should offer PALND to tailor radiation therapy RT which remains the milestone of treatment for LACC.
We report our experience of inclusion of PALND in our treatment algorithm for patients with LACC.
Methodology Three-year(2020–2023)single center retrospective analysis of outcomes of LACC patients(FIGO2018 stages IB3-IIIC1, if pelvic nodes suspected at imaging-PET/CT) who underwent systematic PALND up to level of inferior mesenteric artery. Number of removed nodes, surgical complications and days of hospital stay were considered as proxy for surgical quality. Time between histologic diagnosis of cervical cancer and beginning of RT(DRTT), between surgery and RT(SRTT), overall treatment time(OTT) and dose of RT were considered as proxy of effectiveness of diagnostic and therapeutic algorithm.
Results Thirteen patients underwent PALND via laparoscopic(11) or robotic surgery(2). In 1 case, histology after PALND revealed micrometastatic paraortic nodes not suspected at preoperative imaging, upstaging the patient to IIIC2stage. The mean number of removed nodes were 15(range6–30). Mean hospital stay was 3.5days(2–8). There was 1 surgical intraoperative complication(ureteral section repaired with end-to-end anastomosis and stent) without long term effect. Mean DRTT was 97days(63–168) and SRTT 56days(25–125), reduced to 79 and 40days respectively excluding two cases that started chemotherapy alone for advanced metastatic disease at restaging. OTT of RT was 55days. Mean total dose of RT(EBRT+BT) EQD210 was 84.4Gy(81.9–87.7). One patient with metastatic disease died for cancer, 1 patient had vaginal recurrence 14 months after the end of RT.
Conclusion According to our experience, in appropriate setting, inframesenteric PALND for LACC is a safe procedure and has the potential to identify micrometastatic paraortic nodes not detected at imaging, without compromising effectiveness of RT.
Disclosures Authors declare no conflict of interest.
