Extraperitoneal pelvic lymph node dissection with laparotomy in occult invasive cervical cancer found after a simple hysterectomy

Purpose of Investigation: To evaluate the authors' experience and clinical outcomes of extraperitoneal pelvic lymph node dissection (EPLND) and subsequent radiotherapy with concomitant chemotherapy in 21 patients with invasive cervical cancer found in simple hysterectomy. Materials and Methods: The authors reviewed the data of patients with occult invasive cervical cancer (OICC) detected after simple hysterectomy carried out for benign gynecologic conditions or preinvasive cervical lesions from 2007 to 2017. Results: All patients were classified into three groups as low risk, high risk, and specially selected according to pathological reports and imaging methods. All patients were staged IA1 to 2B and all pathological reports revealed squamous cell carcinoma. There were 6, 13, and 2 patients in the high-risk group, low-risk group, and specially selected group; respectively. During a median follow-up of 39 months, patients did not show any recurrence. All adjuvant chemoradiation therapy was initiated at three weeks postoperatively without delay. There were two postoperative complications. The mean operation time regarding extraperitoneal lymph node dissection (ELND) was 33.66 +/- 5.36 minutes and median postoperative hospital stay was two days. Conclusions: Optimal treatment plan can be made after pathological examination and interpretation of imaging methods in patients with OICC after simple hysterectomy (SH). EPLND may be considered as a safe and reliable first-line surgical option in the management of patients with OICC after SH.