title: Metastasis to deep obturator and para-aortic lymph nodes in 649 patients with cervical carcinoma.
abstract: OBJECTIVE
  The extent of retroperitoneal lymph node dissection for early stage cervical cancer remains debatable. Our study aimed to investigate the incidence of metastases in deep obturator lymph nodes (DOLNs) and para-aortic lymph nodes (PALNs) and its association with clinicopathological factors in cervical carcinoma.
  
  
  METHODS
  Six hundred and forty-nine patients with stage IB to IIB cervical cancer underwent radical hysterectomy, pelvic lymphadenectomy and/or para-aortic lymphadenectomy. The incidence and distribution of metastases in retroperitoneal lymph nodes and the associated factors were analyzed.
  
  
  RESULTS
  Metastases in pelvic lymph nodes (PLNs) were found in 175 patients. Of the 175 cases with positive PLNs, 15 had DOLN metastases. Only two cases without PLN metastases had positive DOLNs. There was no significant correlation between DOLN metastasis and tumor histology, differentiation or capillary lymphatic space involvement. PALN metastasis occurred in 19 of 137 patients with cervical lesions larger than 2 cm in diameter. Eighteen of the 19 patients also had PLN involvement. Logistic regression analysis showed that PLN metastasis and larger tumors were independent risk factors for metastasis to PALNs.
  
  
  CONCLUSIONS
  DOLN metastasis is not common and may be secondary to metastasis to other PLNs. Routine removal of DOLNs might be unnecessary when PLNs are negative. Para-aortic sampling or lymphadenectomy should be considered when the PLNs are positive or/and the cervical lesion is larger than 2 cm.
authors: Department of Gynecologic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, PR China. Huangh@sysucc.org.cn
authors: H
authors: H
authors: Huang
authors: J
authors: J
authors: Liu
authors: Y
authors: Y
authors: Li
authors: T
authors: T
authors: Wan
authors: Y
authors: Y
authors: Feng
authors: Z
authors: Z
authors: Li
authors: Q
authors: Q
authors: Huang
mesh_terms: D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal; D002681:China / Q000453:epidemiology; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000453:epidemiology* / Q000556:secondary* / Q000628:therapy; D018482:Muscle, Skeletal; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D055815:Young Adult