Gynecologic oncology · 2026
Para-aortic lymphadenectomy after negative PET-CT in locally advanced cervical cancer: a continuous monocentric series of 320 cases.
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Daix-Moreux Mathilde, El Hajj Houssein, Schérier Stéphanie, Deandréis Désirée, Chaffai Ines, Limkin Elaine, Espenel Sophie, Pautier Patricia, Leary Alexandra, Michels Judith, Genestie Catherine, Morice Philippe, Gouy Sébastien
Аннотация
OBJECTIVE: Assess the accuracy of preoperative PET-CT in detecting para-aortic nodal metastasis in patients with locally-advanced cervical cancer, using routine laparoscopic para-aortic lymphadenectomy and evaluate its impact on patient outcomes.
METHODS: We retrospectively analyzed a cohort of 320 patients with locally advanced cervical cancer patients (2007-2020). All patients had negative para-aortic PET-CT findings and underwent staging laparoscopic para-aortic lymphadenectomy up to the left renal vein. Collected data included patients and tumors' characteristics, surgical procedures, and complications. The association between nodal status, size of metastatic nodes and survivals were also analyzed.
RESULTS: Twenty-nine (9%) patients had para-aortic nodal metastases: 11 < 5 mm and 18 > 5 mm. The rates of false negative results for para-aortic nodal metastases were significantly correlated with the pelvic lymph node status on PET-CT imaging: 3.3% in patients without pelvic uptake compared to 16.9% in patients with pelvic uptake (p < 0.001), but not significantly linked with its laterality, uni or bilateral uptake. Patients with nodal metastases ≤5 mm did not have a different survival from pN0 patients but those with metastases >5 mm had an increased risk of death (HR = 2.79 (95%CI [1.19-6.54], p = 0.02). Among 12 patients in whom para-aortic nodal metastases location is known, 4 (33%) had isolated nodes above the inferior mesenteric artery).
CONCLUSION: Para-aortic lymphadenectomy may be omitted in locally advanced cervical cancer patients without pelvic lymph node uptake on PET-CT. It remains valuable in patients with pelvic uptake. If performed, dissection up to the left renal vein allows for an accurate assessment of the para-aortic area.
METHODS: We retrospectively analyzed a cohort of 320 patients with locally advanced cervical cancer patients (2007-2020). All patients had negative para-aortic PET-CT findings and underwent staging laparoscopic para-aortic lymphadenectomy up to the left renal vein. Collected data included patients and tumors' characteristics, surgical procedures, and complications. The association between nodal status, size of metastatic nodes and survivals were also analyzed.
RESULTS: Twenty-nine (9%) patients had para-aortic nodal metastases: 11 < 5 mm and 18 > 5 mm. The rates of false negative results for para-aortic nodal metastases were significantly correlated with the pelvic lymph node status on PET-CT imaging: 3.3% in patients without pelvic uptake compared to 16.9% in patients with pelvic uptake (p < 0.001), but not significantly linked with its laterality, uni or bilateral uptake. Patients with nodal metastases ≤5 mm did not have a different survival from pN0 patients but those with metastases >5 mm had an increased risk of death (HR = 2.79 (95%CI [1.19-6.54], p = 0.02). Among 12 patients in whom para-aortic nodal metastases location is known, 4 (33%) had isolated nodes above the inferior mesenteric artery).
CONCLUSION: Para-aortic lymphadenectomy may be omitted in locally advanced cervical cancer patients without pelvic lymph node uptake on PET-CT. It remains valuable in patients with pelvic uptake. If performed, dissection up to the left renal vein allows for an accurate assessment of the para-aortic area.