Para-aortic lymph node metastases in locally advanced cervical cancer: comparing surgical staging and PET-CT staging in 336 patients

Aims Aim of this study is to compare the results of surgical staging with imaging (PET-CT,PET or CT) of the para-aortic lymph nodes (PAOLN) in locally advanced cervical cancer (LACC). Methods Monocentric retrospective study of 336 patients with cervical cancer FIGO stage IB2-IVa, diagnosed between December 1994 and August 2013. Patients underwent staging of the PAOLN using imaging by PET-CT, PET or CT. 204 Patients with normal or not overt malignant imaging results underwent surgical endoscopic para-aortic staging (SS). When PAOLN metastases were for sure present on imaging, no surgical staging followed. The patient group was divided into 4: positive (S+), or negative SS (S-), positive imaging without SS (I+) and negative imaging with no result of SS (I-/no S). Results Twenty (5.9%) patients had overt PAOLN metastases on imaging. 13 patients (7.3%) had metastases in the PAO nodes at pathological examination despite negative imaging results . Of 10 patients with suspicious but not overtly malignant PAOLN imaging, 3 had positive PAOLN. Overall, 16 patients (8.5%) had positive PAOLN after surgical staging. Peroperative complications were minor. The median follow-up was 31 months (1?218). Overall survival at 2 years were 40% for S+, 83% for S-, 58% for I+, and 69% for I-/no S (p