Introduction/Background This study aimed to assess the impact of para-aortic lymphadenectomy (PAL) in locally advanced cervical cancer (LACC) patients, focusing on the accuracy of preoperative PET-CT scans in detecting para-aortic nodal metastasis (PANM) and its impact on patient outcomes.

Methodology A comprehensive prospective analysis was conducted on LACC patients with negative para-aortic PET-CT results who underwent staging surgery. Data from a single-center database were collected, including patient characteristics, tumor details, surgical procedures, and complications. Histology served as the gold standard for PANM diagnosis. Survival analysis also evaluated the association between PANM status and overall survival.

Results The study found a significant correlation between false-negative rates in para-aortic PET-CT scans and the presence of pelvic lymph node involvement: in the absence of pelvic metastatic lymph node involvement (PMLN), we found 3.3% of false negative patients in para-aortic PET-CT, whereas in case of unilateral PMLN and bilateral PMLN, these were respectively 16.3% and 17.9%.

Conclusion In conclusion, PAL may not be necessary for LACC patients without pelvic lymph node involvement on PET-CT, as the false-negative rate in para-aortic PET-CT scans is low. However, for those with pelvic lymph node involvement, staging PAL remains relevant, particularly for patients with micro-metastatic PANM on the pathology report. These findings emphasize the importance of accurate staging and tailored treatment strategies for LACC patients with para-aortic nodal involvement, highlighting the need for further research and improved patient selection, especially those with macro-metastatic disease.

Disclosures The author declares that she has no relevant material nor financial interests that relate to the research described in this paper.