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        The extent of aortic lymphadenectomy in locally advanced cervical cancer impacts on survival

        Antoni Llueca,Javier Escrig,Antonio Gil-Moreno,Virginia Benito,Alicia Hernández,Berta Díaz-Feijoo 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.1

        Objective: The prognostic impact of surgical paraaortic staging remains unclear in patientswith locally advanced cervical cancer (LACC). The objective of our study was to evaluate theresults of the surgical technique of preoperative aortic lymphadenectomy in LACC related totumor burden and disease spread to assess its influence on survival. Methods: Data of 1,072 patients with cervical cancer were taken from 11 Spanishhospitals (Spain-Gynecologic Oncology Group [GOG] working group). Complete aorticlymphadenectomy surgery (CALS) was considered when the lymph nodes (LNs) were excisedup to the left renal vein. The extent of the disease was performed evaluating the LNs bycalculating the geometric means and quantifying the log odds between positive LNs andnegative LNs. The Kaplan-Meier method was used to estimate the survival distribution. A Coxproportional hazards model was used to account for the influence of multiple variables. Results: A total of 394 patients were included. Pathological analysis revealed positiveaortic LNs in 119 patients (30%). LODDS cut-off value of −2 was established as a prognosticindicator. CALS and LODDS <−2 were associated with better disease free survival and overallsurvival than suboptimal aortic lymphadenectomy surgery and LODDS ≥−2. In a multivariatemodel analysis, CALS is revealed as an independent prognostic factor in LACC. Conclusion: When performing preoperative surgical staging in LACC, it is not advisable totake simple samples from the regional nodes. Radical dissection of the aortic and pelvicregions offers a more reliable staging of the LNs and has a favorable influence on survival.

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