Purpose: Management for stage IB cervical cancer with intraoperative positive pelvic lymph nodes (LNs) is controversial. We compare 5-year survival rates for women with completed vs. abandoned radical hysterectomy (RH) who were treated with postoperative radiation therapy (RT).
Patients and methods: We identified all women diagnosed with stage IB cervical carcinoma from the Surveillance, Epidemiology, and End Results database from 1988-1998. Women with positive LN involvement who had undergone a complete pelvic and para-aortic lymphadenectomy were compared for 5-year survival based on whether a RH was completed or abandoned at the time of surgery. All women then received postoperative RT. Survival rates were calculated using the Kaplan-Meier method, and the Chi square test was used for all univariate analysis.
Results: From a cohort of 3116 women diagnosed with stage IB cervical cancer, 265 (8.7%) had positive pelvic LNs and a complete pelvic and para-aortic lymphadenectomy. Of these women, 163 had completion of their RH while RH was abandoned in 55. Positive pelvic LNs averaged 2.58+/-2.37 in the completed RH group and 2.42+/-1.63 in the abandoned RH group. Median follow-up was 6.42 years in the completed RH group and 5.75 years in the abandoned RH group. Five-year survival for the completed RH group was 69% compared with 71% in patients with abandoned RH (p=0.46).
Conclusions: Treatment for patients with positive pelvic LNs at the time of RH should be determined by overall morbidity of therapy since equivalent 5-year survival was found between the completed and abandoned RH groups.