Effects of extraperitoneal lymph node dissection vs. imaging methods on survival in staging before radiotherapy in advanced cervical cancer

Background: Effects of extraperitoneal lymph node (LN) dissection and imaging on survival were investigated in staging before primary radiotherapy in locally-advanced cervical cancer (LACC). Materials and Methods: This retrospective study included 145 LACC patients (IIB-IVA 2018 FIGO) between December 2010 and April 2024 at Selcuk University, Faculty of Medicine. Sixty-four patients undergoing surgical staging (Group 1) and 81 undergoing staging through magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography CT (PET-CT) (Group 2) were evaluated. Pelvic or extended-field radiotherapy treatment was administered for para-aortic LN positivity. The effects on survival were statistically analyzed using the staging method. Results: Mean age of 145 cases was calculated as 60.0±11.8 (33-93 years). Mean diameter of cervical primary mass was calculated as 51.3±16.4 mm. Histological type was determined as squamous cells in 134 cases (92.4%). Forty-eight (33.1%), 72 (49.7%), and 25 (17.2%) cases were determined as stages II, III, and IV, respectively; additionally, recurrence was detected in 38 cases (26.2%). In Group 1, removed median pelvic and paraaortic LNs were calculated as four (0-42) and nine (2-24), respectively. While para-aortic LN and isolated pelvic positivities were detected in one (1.6%) and 16 cases (25.0%) and respectively, both pelvic and para-aortic LN positivity was detected in 12 cases (18.8%). Surgical staging revealed a statistically significant difference regarding more locoregional-recurrence-free survival (p=0.026), distant-metastasis-free survival (p=0.023), progression-free survival (p=0.035), and overall survival (p=0.016) than imaging staging. Conclusion: We found that surgical staging had a better prognosis for survival than imaging methods in LACC staging.