title: Extraperitoneal lymph node dissection in locally advanced cervical cancer; the prognostic factors associated with survival.
abstract: Surgical staging was recently recommended for the decision of treatment in locally advanced cervical cancer. We aimed to investigate clinical outcomes as well as factors associated with overall survival (OS) in patients with locally advanced cervical cancer who had undergone extraperitoneal lymph node dissection and were managed according to their lymph node status.
  
  
  
  The medical records of 233 women with stage IIb-IVa cervical cancer who were clinically staged and underwent extraperitoneal lymph node dissection were retrospectively reviewed. Paraaortic lymph node status determined the appropriate radiotherapeutic treatment field. Surgery-related complications and clinical outcomes were evaluated.
  
  
  
  The median age of the patients was 52 years (range, 26-88 years) and the median follow-up time was 28.4 months (range, 3-141 months). Thirty-one patients had laparoscopic extraperitoneal lymph node dissection and 202 patients underwent laparotomy. The number of paraaortic lymph nodes extracted was similar for both techniques. Sixty-two (27%) of the 233 patients had paraaortic lymph node metastases. The 3-year and 5-year OS rates were 55.1% and 46.5%, respectively. The stage of disease, number of metastatic paraaortic lymph nodes, tumor type, and paraaortic lymph node status were associated with OS. In multivariate Cox regression analyses, tumor type, stage, and presence of paraaortic lymph node metastases were the independent prognostic factors of OS.
  
  
  
  Paraaortic lymph node metastasis is the most important prognostic factor affecting survival. Surgery would give hints about the prognosis and treatment planning of the patient.
authors.affiliation: Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey.
authors.forename: Mehmet Faruk
authors.initials: MF
authors.lastname: Köse
authors.affiliation: Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey.
authors.forename: Mine
authors.initials: M
authors.lastname: Kiseli
authors.affiliation: Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey.
authors.forename: Günsu
authors.initials: G
authors.lastname: Kimyon
authors.affiliation: Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey.
authors.forename: Reyhan
authors.initials: R
authors.lastname: Öcalan
authors.affiliation: Department of Gynecologic Oncology, Gülhane Training and Research Hospital, Ankara, Turkey.
authors.forename: Müfit Cemal
authors.initials: MC
authors.lastname: Yenen
authors.affiliation: Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey.
authors.forename: Gökhan
authors.initials: G
authors.lastname: Tulunay
authors.affiliation: Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey.
authors.forename: Ahmet Taner
authors.initials: AT
authors.lastname: Turan
authors.affiliation: Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey.
authors.forename: Işın
authors.initials: I
authors.lastname: Üreyen
authors.affiliation: Department of Gynecologic Oncology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey.
authors.forename: Nurettin
authors.initials: N
authors.lastname: Boran
keywords: Cervical cancer; extraperitoneal lymph node.