1109 Para-aortic lymph node recurrence in surgically treated apparent early-stage cervical cancer: experience from a tertiary referral cancer center

Introduction/Background To date, the surgical approach to early-stage cervical cancer includes simple or radical hysterectomy with pelvic lymphadenectomy +/- bilateral salpingo-oophorectomy. The role of para-aortic lymphadenectomy remains optional and debated. The primary objective of this study was to estimate the para-aortic recurrence rate in surgically treated patients with apparent early-stage cervical cancer. Methodology We included all consecutive presumed early-stage squamous cell carcinoma and usual-type adenocarcinoma of the cervix who had undergone surgery at the European Institute of Oncology, Milan, from 01/2010 to 12/2021. Patients undergoing para-aortic lymphadenectomy, para-aortic radiotherapy, neoadjuvant treatment, incomplete nodal assessment, and stage IV were excluded from the analysis. Recurrence rate and recurrence-free survival (RFS) were estimated using appropriate statistical analysis. Results Overall, 424 patients were included (figure 1.A). At final pathology, an early-stage cervical cancer (IA1-IIA1) was diagnosed in 337 (79.5%) patients, locally advanced (IB3-IIB) and distant disease (III) were diagnosed in the remaining 25 (5.9%) and 62 (14.6%) patients, respectively. In total, 104 patients (24.5%) underwent adjuvant pelvic radiotherapy +/- chemotherapy, 4 patients (1%) received adjuvant chemotherapy alone, while the remaining 316 (74.5%) were observed. Overall, 42 (9.9%) patients experienced a recurrence with a median time of 18 months (IQR 8–26) and a median time of follow-up for the remaining 382 (90.1%) patients of 71.5 months (IQR 39–98). Among the 42 relapses only 3 (0.71%) were located in the para-aortic lymph node of which 2 (0.5%) were isolated and 1 (0.25%) involved both the para-aortic and pelvic lymph nodes. The 5-year RFS in the overall population was 0.89 95%CI: 0.86–0.92 (figure 1.B). Conclusion Given the low rate of para-aortic lymph node recurrence and the risk of intra and postoperative complications related to para-aortic lymphadenectomy, our study supports the omission of para-aortic lymphadenectomy during the surgical staging of cervical cancer. Further studies are needed to validate these findings. Disclosures None.