Paraaortic Lymphadenectomy in Surgical Treatment of Cervical Cancer in FIGO IB Stage of the Disease

Introduction. Precise assessment of lymph nodes status has an important role in diagnosis, prognosis and treatment of women with cervical cancer. Aims: Determining diagnostic value of paraaortal lymphadenectomy in lymph node status assessment, and defining high-risk group of patients who have metastases in paraaortal lymph nodes and require adjuvant therapy in FIGO stage IB cervical cancer. Material and methods. Open prospective study was conducted in the period from 2017- 2020 in Clinical Center of Vojvodina on 80 patients with histopathologically verified cervical cancer in FIGO stage IB. Postoperative assessment of surgical-pathological stage was based on histopathological examination of surgically removed material and lymph nodes, classified into anatomical groups in pelvic and paraaortal region. Results. Average number of lymph nodes removed by paraaortal lymphadenectomy per patient was 13. Macroscopically enlarged positive lymph nodes (size greater than1cm) were found in 6 (7.5 %) patients. Metastases in paraaortal lymph nodes were found in 8 (10 %) patients. The most common localization of lymph metastases was in paraaortal group of lymph nodes. Ratio of inframesenteric and supramesenteric localization of metastases in paraaortal lymph groups was 70: 30. In 50 % of patients with positive paraaortal lymph nodes, more than 2 paraaortal lymph groups were involved. Bilateral pelvic lymph metastases, metastases in common iliac group of lymph nodes and multiple pelvic lymph metastases are independent predictors of lymph metastases in paraaortal region. Sensitivity of MRI in detection of paraaortal lymph nodes was 38 %, and specificity 93 %. MRI examination showed falsely negative results in 5 (6.25 %) patients and falsely positive results in 5 (6.25 %) patients. Initial treatment plan defined by clinical and MRI findings, was altered based on paraaortal lymphadenectomy results in 10 (12.5 %) patients. Average operation length was 188.6 minutes. Overall rate of operative compl