Comparison of Survival Outcomes with or Without Para-aortic Lymphadenectomy in Surgical Patients with Stage IB1-IIA2 Cervical Cancer in China from 2004-2016

Abstract

Background: Current opinions on whether surgical patients with cervical cancer should undergo para-aortic lymphadenectomy at the same time are inconsistent. The present study examined differences in survival outcomes with or without para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer.Methods: We retrospectively compared the survival outcomes of 8802 cervical cancer patients with stage IB1-IIA2 (FIGO 2009) from 37 hospitals in mainland China, who underwent abdominal radical hysterectomy + pelvic lymphadenectomy (n=8445) or abdominal radical hysterectomy + pelvic lymphadenectomy + para-aortic lymphadenectomy (n=357).Results: Among the 8802 patients with stage IB1-IIA2 cervical cancer, 1618 (18.38%) patients had postoperative pelvic lymph node metastasis, and 37 (10.36%) patients had para-aortic lymph node metastasis. When pelvic lymph node metastasized, the para-aortic lymph node simultaneous metastasis rate was 30.00% (36/120). The risk of isolated para-aortic lymph node metastasis was 0.42% (1/237). There were no significant differences in the survival outcomes between the para-aortic lymph node unresected and resected groups. No differences in the survival outcomes were found before or after matching between the two groups regardless of pelvic lymph node negativity/positivity. Conclusion: Para-aortic lymphadenectomy did not improve 5-year survival outcomes in surgical patients with stage IB1-IIA2 cervical cancer. Therefore, when pelvic lymph node metastasis is negative, the risk of isolated para-aortic lymph node metastasis is very low, and para-aortic lymphadenectomy is not recommended. When pelvic lymph node metastasis is positive, para-aortic lymphadenectomy should be carefully selected because of the high risk of this procedure.

Laparoscopic Versus Abdominal Radical Hysterectomy for Cervical Cancer

“…The overall grasp of the visual field avoids the omission of small active bleeding foci in the surgical field of view, and can effectively stop bleeding in time, thereby significantly reducing the amount of bleeding on the surgical wound and avoiding the occurrence of major bleeding. [46][47][48] The results of this study have showed that the time of the time to the first passage of flatus in the LRH is earlier than that of ARH. The possible reason for the difference may be that laparoscopic surgery avoids the touch of the abdominal retractor, gauze and operator's gloves on the intestine, and the less intestinal tract manipulations in the LRH reduce irritation to the patient's gastrointestinal tract.…”

“…When the laparoscopic eyepiece is retreated, the surgical field of view can be expanded, and the operator’s awareness of the operation can be improved. The overall grasp of the visual field avoids the omission of small active bleeding foci in the surgical field of view, and can effectively stop bleeding in time, thereby significantly reducing the amount of bleeding on the surgical wound and avoiding the occurrence of major bleeding 46–48…”