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Abstract
Introduction/Background The standard treatment of early-stage cervical cancer is radical hysterectomy with pelvic lymphadenectomy(PL). However, since the percentage of patients with nodal involvement in early stages is low, and the associated morbidity of PL is high, there is a growing interest in determining potential differences in terms of survival between the nodal assessment using sentinel lymph node biopsy(SLNB) alone or the standard PL.Two recent systematic reviews showed that there appears to be no increased risk of recurrence in patients with early-stage cervical cancer who underwent SLNB alone. Despite these data, the evidence to date remains insufficient.The aim of this study was to assess if there were statistically significant differences in terms of overall survival(OS) and progression-free survival(PFS) between PL and SLNB alone for the nodal assessment of patients with early-stage cervical cancer.
Methodology A retrospective study was conducted among patients with early-stage cervical cancer who underwent radical surgery with pelvic lymph node assessment at La Paz University Hospital between 2005 and 2022.For nodal staging, either PL, SLNB+PL or exclusive SLNB were performed depending on the time period.Kaplan-Meier survival curves were compared between PL and SLNB groups.Predictors of bilateral SLN detection were identified with cox proportional hazard models.
Results Among the 128 patients included, PL+/-SLNB was performed in 79(61.7%) patients and exclusive SLNB in 49(38.3%) patients.There were no differences between PL and SLNB in OS or PFS (p=0.0730 and p=0.0189 respectively).However, the multivariate analysis showed that the SLNB learning curve was significantly associated with higher sentinel node bilateral detection rate(p=0.037).Lower limb lymphedema(LLL) was significantly lower in the SLNB group(p=0.001).
Conclusion Pelvic nodal assessment with SLNB alone did not worsen survival rates compared to PL in patients with early-stage cervical cancer, and it is associated with a lower rate of LLL.The surgical experience of the center is essential for a proper sentinel lymph node detection.
Disclosures Any.
OS comparing patients who underwent pelvic lymphadenectomy (with or without SLNB) and only SLNB
PFS comparing patients who underwent pelvic lymphadenectomy (with or without SLNB) and only SLNB