title: Pelvic lymphadenectomy improves survival in patients with cervical cancer with low-volume disease in the sentinel node: a retrospective multicenter cohort study.
abstract: OBJECTIVE
  In this study, we aimed to describe the value of pelvic lymph node dissection (LND) after sentinel lymph node (SN) biopsy in early-stage cervical cancer.
  
  
  METHODS
  We performed a retrospective multicenter cohort study in 8 gynecological oncology departments. In total, 645 women with International Federation of Gynecology and Obstetrics stage IA to IIB cervical cancer of squamous, adeno, or adenosquamous histologic type who underwent SN biopsy followed by pelvic LND were enrolled in this study. Radioisotope tracers and blue dye were used to localize the sentinel node, and pathologic ultrastaging was performed.
  
  
  RESULTS
  Among the patients with low-volume disease (micrometastases and isolated tumor cells) in the sentinel node, the overall survival was significantly better (P = 0.046) if more than 16 non-SNs were removed. No such significant difference in survival was detected in patients with negative or macrometastatic sentinel nodes.
  
  
  CONCLUSIONS
  Our findings indicate that in patients with negative or macrometastatic disease in the sentinel nodes, an additional LND did not alter survival. Conversely, our data suggest that the survival of patients with low-volume disease is improved when more than 16 additional lymph nodes are removed. If in a prospective trial our data are confirmed, we would suggest a 2-stage operation.
authors.affiliation: *Division of Woman and Baby, Department of Gynaecological Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; †Department of Obstetrics and Gynecology, Gynecological Oncology Centre, First Faculty of Medicine and General University Hospital, Charles University, Prague; ‡Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic; §Institut Claudius Regaud, Toulouse; ∥Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, European Georges-Pompidou Teaching Hospital, Paris, France; ¶Jagiellonian University Medical College, Krakow, Poland; #University Hospital Ostrava, Ostrava, Czech Republic; and **Center for Gynaecologic Oncology Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Afra
authors.initials: A
authors.lastname: Zaal
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Zweemer
authors.forename: Michal
authors.initials: M
authors.lastname: Zikán
authors.forename: Ladislav
authors.initials: L
authors.lastname: Dusek
authors.forename: Denis
authors.initials: D
authors.lastname: Querleu
authors.forename: Fabrice
authors.initials: F
authors.lastname: Lécuru
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Bats
authors.forename: Robert
authors.initials: R
authors.lastname: Jach
authors.forename: Libor
authors.initials: L
authors.lastname: Sevcik
authors.forename: Petar
authors.initials: P
authors.lastname: Graf
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Klát
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Dyduch
authors.forename: Silvia
authors.initials: S
authors.lastname: von Mensdorff-Pouilly
authors.forename: Gemma G
authors.initials: GG
authors.lastname: Kenter
authors.forename: René H M
authors.initials: RH
authors.lastname: Verheijen
authors.forename: David
authors.initials: D
authors.lastname: Cibula
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D010388:Pelvis / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D013534:Survival; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*