Para-aortic lymphadenectomy after negative PET-CT in locally advanced cervical cancer: a continuous monocentric series of 320 cases

• PET-CT false-negative rate for para-aortic nodes was 9% overall. • Pelvic uptake raised para-aortic false negatives to 16.9%. • Para-aortic metastases >5 mm significantly worsened survival. • One-third of mapped cases had isolated nodes above the Inferior mesenteric artery. • Findings support para-aortic lymphadenectomy when pelvic uptake is present. PET-CT false-negative rate for para-aortic nodes was 9% overall. Pelvic uptake raised para-aortic false negatives to 16.9%. Para-aortic metastases >5 mm significantly worsened survival. One-third of mapped cases had isolated nodes above the Inferior mesenteric artery. Findings support para-aortic lymphadenectomy when pelvic uptake is present. Assess the accuracy of preoperative PET-CT in detecting para-aortic nodal metastasis in patients with locally-advanced cervical cancer, using routine laparoscopic para-aortic lymphadenectomy and evaluate its impact on patient outcomes. We retrospectively analyzed a cohort of 320 patients with locally advanced cervical cancer patients (2007–2020). All patients had negative para-aortic PET-CT findings and underwent staging laparoscopic para-aortic lymphadenectomy up to the left renal vein. Collected data included patients and tumors' characteristics, surgical procedures, and complications. The association between nodal status, size of metastatic nodes and survivals were also analyzed. Twenty-nine (9%) patients had para-aortic nodal metastases: 11 5 mm. The rates of false negative results for para-aortic nodal metastases were significantly correlated with the pelvic lymph node status on PET-CT imaging: 3.3% in patients without pelvic uptake compared to 16.9% in patients with pelvic uptake ( p 5 mm had an increased risk of death (HR = 2.79 (95%CI 1.19–6.54, p = 0.02). Among 12 patients in whom para-aortic nodal metastases location is known, 4 (33%) had isolated nodes above the inferior mesenteric artery). Para-aortic lymphadenectomy may be omitted in locally advanced cervical cancer patients without pelvic lymph node uptake on PET-CT. It remains valuable in patients with pelvic uptake. If performed, dissection up to the left renal vein allows for an accurate assessment of the para-aortic area.