Predictive Factors Of Para-Aortic Lymph Nodes Metastasis And Survival Advantages Of Para-Aortic Lymphadenectomy In Early Stage Cervical Cancer

Background: Performing dissection of para-aortic lymph nodes (LNs) during radical hysterectomy is still optional and must be individualized. The clinical benefits of performing lymphadenectomy are not only for detection of occult metastases but it could positively affect the survival of patients.Aim of the Study: To assess the predictive clinical and pathologic parameters of occurrence of para-aortic LNs metastasis in early stage cervical cancer patients (stages I and II) in addition to evaluate of the effect of the extent of lymphadenectomy on patients' survival.Patients and Methods: We included 60 patients with cancer cervix stages I-II, we randomly divided them into the following: first group was managed by radical hysterectomy, dissection of both pelvic and para-aortic LNs and second group underwent radical hysterectomy with dissection of only pelvic LNs.Results: We found that presence of deep stromal and uterine body invasion, ovarian spread, presence of pelvic LN metastasis, and presence of gross enlargement of para-aortic LN were related to positive para-aortic LNs (p < 0.001). Patients with para-aortic LNs metastases have unfavorable disease-free survival (DFS) and unfavorable overall survival (OS) rates (p < 0.001). DFS and OS rates were more favorable in patients who underwent para-aortic lymphadenectomy than the other group who underwent only pelvic lymphadenectomy.Conclusions: Predictive factors for para-aortic LNs metastases in patients with early stage cervical cancer are presence of lympovascular invasion and pelvic LNs spread. Additionally performing para-aortic lymphadenectomy has survival benefits mainly in high-risk patients with higher stage and widespread pelvic LNs metastases. Clinical Registration Number, NCT03361730.