title: Can sentinel lymph node biopsy replace pelvic lymphadenectomy for early cervical cancer?
abstract: OBJECTIVE
  Evaluate recurrence-free survival (RFS) and short-term morbidity in patients with early cervical cancer who undergo bilateral pelvic lymphadenectomy (BPLND) versus bilateral sentinel lymph node biopsy only (BSLNB) at primary surgery.
  
  
  METHODS
  All patients with pathologically confirmed node negative stage IA/IB cervical cancer managed with BPLND or BSLNB were identified in the University of Toronto's prospective cervical cancer database from May 1984-June 2015. Groups were compared with Wilcoxon rank-sum, Chi-square, and Fisher's exact tests. Predictors of RFS were identified with Cox proportional hazard models. Kaplan-Meier survival curves were compared. Statistical significance was p<0.05.
  
  
  RESULTS
  1188 node negative patients were identified, BPLND-1078; BSLNB-110. There was no difference between BPLND and BSLNB in 2 and 5year RFS (95% vs 97% and 92% vs 93% respectively), tumor size, histology, invasion depth, intra-operative complications or short-term morbidity. BPLND was associated with increased surgical time (2.8 vs 2.0h, p<0.001), blood loss (500mL vs 100mL, p<0.001), transfusion (23% vs 0%, p<0.001) and post-operative infection (11% vs 0%, p=0.001). Age, surgery date, stage, LVSI, and radicality of surgery differed between groups. Controlling for age, stage, LVSI, invasion depth and histology, there was no significant difference in RFS between groups. Only invasion depth, LVSI and histology were predictors of RFS.
  
  
  CONCLUSIONS
  A negative BSLNB is not associated with a difference in RFS compared to a negative BPLND. Short-term morbidity may be reduced, however due to the long study period, changes in demographics and surgery may contribute to differences noted.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, M700-610 University Avenue, Toronto, ON M5G 2M9, Canada. Electronic address: Genevieve.Lennox@sunnybrook.ca.
authors.forename: Genevieve K
authors.initials: GK
authors.lastname: Lennox
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, M700-610 University Avenue, Toronto, ON M5G 2M9, Canada; Division of Gynecologic Oncology, T2051 Odette Cancer Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. Electronic address: al.covens@sunnybrook.ca.
authors.forename: Allan
authors.initials: A
authors.lastname: Covens
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D001808:Blood Vessels / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology; D008197:Lymph Node Excision / Q000009:adverse effects*; D042601:Lymphatic Vessels / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D061646:Operative Time; D010388:Pelvis; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects*; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
keywords: Cervical carcinoma; Pelvic lymphadenectomy; Recurrence; Sentinel lymph node biopsy