title: Role of pelvic and para-aortic lymphadenectomy in abandoned radical hysterectomy in cervical cancer.
abstract: BACKGROUND
  Cervical cancer (CC) occupies fourth place in cancer incidence and mortality worldwide in women, with 560,505 new cases and 284,923 deaths per year. Approximately, nine of every ten (87%) take place in developing countries. When a macroscopic nodal involvement is discovered during a radical hysterectomy (RH), there is controversy in the literature between resect macroscopic lymph node compromise or abandonment of the surgery and sending the patient for standard chemo-radiotherapy treatment. The objective of this study is to compare the prognosis of patients with CC whom RH was abandoned and bilateral pelvic lymphadenectomy and para-aortic lymphadenectomy was performed with that of patients who were only biopsied or with removal of a suspicious lymph node, treated with concomitant radiotherapy/chemotherapy in the standard manner.
  
  
  METHODS
  A descriptive and retrospective study was conducted in two institutions from Mexico and Colombia. Clinical records of patients with early-stage CC programmed for RH with an intraoperative finding of pelvic lymph, para-aortic nodes, or any extracervical involvement that contraindicates the continuation of surgery were obtained. Between January 2007 and December 2012, 42 clinical patients complied with study inclusion criteria and were selected for analysis.
  
  
  RESULTS
  In patients with CC whom RH was abandoned due to lymph node affectation, there is no difference in overall survival or in disease-free period between systematic lymphadenectomy and tumor removal or lymph node biopsy, in pelvic lymph nodes as well as in para-aortic lymph nodes, when these patients receive adjuvant treatment with concomitant radiotherapy/chemotherapy.
  
  
  CONCLUSIONS
  This is a hypothesis-generator study; thus, the recommendation is made to conduct randomized prospective studies to procure better knowledge on the impact of bilateral pelvic and para-aortic lymphadenectomy on this group of patients.
authors.affiliation: Departamento de Ginecología Oncológica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22 Col. Sección XVI Del. Tlalpan, Ciudad de Mexico, CP 14080, Mexico.
authors.forename: Salim Abraham
authors.initials: SA
authors.lastname: Barquet-Muñoz
authors.affiliation: Departamento de Ginecología Oncológica, Instituto de Cancerología de Las Américas (ICLA), Diagonal 75B No. 2A - 80/140, Medellin, Colombia.
authors.forename: Gabriel Jaime
authors.initials: GJ
authors.lastname: Rendón-Pereira
authors.affiliation: Departamento de Ginecología Oncológica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22 Col. Sección XVI Del. Tlalpan, Ciudad de Mexico, CP 14080, Mexico.
authors.forename: Denise
authors.initials: D
authors.lastname: Acuña-González
authors.affiliation: Departamento de Gineconcologia, Hospital Medico Quirurgico y Oncologia, del Instituto Salvadoreño del Seguro Social, Alameda Juan Pablo II, San Salvador, El Salvador.
authors.forename: Monica Vanessa Heymann
authors.initials: MV
authors.lastname: Peñate
authors.affiliation: Dirección de Investigación, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22 Col. Sección XVI Del. Tlalpan, Ciudad de Mexico, CP 14080, Mexico.
authors.forename: Luis Alonso
authors.initials: LA
authors.lastname: Herrera-Montalvo
authors.affiliation: Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22 Col. Sección XVI Del. Tlalpan, Ciudad de Mexico, CP 14080, Mexico.
authors.forename: Lenny Nadia
authors.initials: LN
authors.lastname: Gallardo-Alvarado
authors.affiliation: Departamento de Ginecología Oncológica, Subdirección de Investigación Clínica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22 Col. Sección XVI Del. Tlalpan, Ciudad de Mexico, CP 14080, Mexico. dcantude@gmail.com.
authors.forename: David Francisco
authors.initials: DF
authors.lastname: Cantú-de León
authors.affiliation: Clínica de Oncología ASTORGA, Calle 8 # 43 C 110, Medellin, Colombia.
authors.forename: René
authors.initials: R
authors.lastname: Pareja
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D001011:Aorta / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000401:mortality*; D007124:Immunoenzyme Techniques; D008197:Lymph Node Excision / Q000401:mortality*; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Abandoned radical hysterectomy; Cervical cancer; Systematic lymphadenectomy