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1109 Para-aortic lymph node recurrence in surgically treated apparent early-stage cervical cancer: experience from a tertiary referral cancer center
  1. Tullio Golia D’Augè1,2,
  2. Gabriella Schivardi1,
  3. Luigi Antonio De Vitis1,
  4. Maria Elena Laudani1,
  5. Marina Rosanu1,
  6. Ilaria Betella1,
  7. Simone Bruni1,
  8. Giovanni Damiano Aletti1,3,
  9. Jvan Casarin4,
  10. Angelo Maggioni1,
  11. Nicoletta Colombo1,5,
  12. Vanna Zanagnolo1 and
  13. Francesco Multinu1
  1. 1Department of Gynecology, European Institute of Oncology, IEO, IRCCS, Milan, Italy
  2. 2Department of Gynecological, Obstetrical and Urological Sciences, ‘Sapienza’ University of Rome, Rome, Italy
  3. 3Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
  4. 4Department of Obstetrics and Gynecology, Women and Children Hospital, University of Insubria, Varese, Italy
  5. 5Medical Gynecologic Oncology Unit, University of Milan Bicocca, University of Milan-Bicocca, Milan, Italy


Introduction/Background To date, the surgical approach to early-stage cervical cancer includes simple or radical hysterectomy with pelvic lymphadenectomy +/- bilateral salpingo-oophorectomy. The role of para-aortic lymphadenectomy remains optional and debated. The primary objective of this study was to estimate the para-aortic recurrence rate in surgically treated patients with apparent early-stage cervical cancer.

Methodology We included all consecutive presumed early-stage squamous cell carcinoma and usual-type adenocarcinoma of the cervix who had undergone surgery at the European Institute of Oncology, Milan, from 01/2010 to 12/2021. Patients undergoing para-aortic lymphadenectomy, para-aortic radiotherapy, neoadjuvant treatment, incomplete nodal assessment, and stage IV were excluded from the analysis. Recurrence rate and recurrence-free survival (RFS) were estimated using appropriate statistical analysis.

Results Overall, 424 patients were included (figure 1.A). At final pathology, an early-stage cervical cancer (IA1-IIA1) was diagnosed in 337 (79.5%) patients, locally advanced (IB3-IIB) and distant disease (III) were diagnosed in the remaining 25 (5.9%) and 62 (14.6%) patients, respectively. In total, 104 patients (24.5%) underwent adjuvant pelvic radiotherapy +/- chemotherapy, 4 patients (1%) received adjuvant chemotherapy alone, while the remaining 316 (74.5%) were observed. Overall, 42 (9.9%) patients experienced a recurrence with a median time of 18 months (IQR 8–26) and a median time of follow-up for the remaining 382 (90.1%) patients of 71.5 months (IQR 39–98). Among the 42 relapses only 3 (0.71%) were located in the para-aortic lymph node of which 2 (0.5%) were isolated and 1 (0.25%) involved both the para-aortic and pelvic lymph nodes. The 5-year RFS in the overall population was 0.89 [95%CI: 0.86–0.92] (figure 1.B).

Conclusion Given the low rate of para-aortic lymph node recurrence and the risk of intra and postoperative complications related to para-aortic lymphadenectomy, our study supports the omission of para-aortic lymphadenectomy during the surgical staging of cervical cancer. Further studies are needed to validate these findings.

Disclosures None.

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