The Incidence and Clinical Significance of Paraaortic Lymph Node Metastases in Patients with Uterine Cervical Cancer

Paraaortic lymph node dissection was performed in the treatment of patients with carcinoma of the cervix who were subjected to radical hysterectomy between June, 1982 and March, 1988 at the Department of Obstetrics and Gynecology, Hokkaido University Hospital, Sapporo, Japan. Thirteen out of 246 (5.3%) patients had metastases in the paraaortic lymph node. Of the patients with stage I carcinoma of the cervix, 1.0 per cent had positive paraaortic lymph node. Of the patients with stage II carcinoma, 4.9 per cent had metastases in the paraaortic lymph nodes, and of the stage III patients, 16.7 per cent had positive paraaortic lymph nodes. The incidence of paraaortic node involvement increased along with the advance of the disease. Of the patients with squamous cell carcinoma of the cervix, 4.6 per cent had paraaortic lymph node metastases. Of the patients with adenocarcinoma of the cervix including mixed carcinoma, 6.8 per cent had positive paraaortic node. All the patients with positive paraaortic lymph nodes had metastatic diseases in the pelvic nodes. In addition, the number of groups of positive pelvic nodes in the patients with positive paraaortic lymph nodes was significantly larger than that in those with negative paraaortic nodes. At the time of reporting, seven out of 13 patients with positive paraaortic lymph node have died of the disease. The mean survival period of those seven patients was 14.9±12.2 (mean±SD) months. Of the remaining six surviving patients, three have been doing well for more than three years. These data suggested that paraaortic lymph node dissection might be withheld in treatment of a patient with stage I carcinoma of the cervix. Further treatment can be individualized in the treatment of patients with stage II and III carcinoma of the cervix by paraaortic node dissection, and an improvement in the prognosis of patients with positive paraaortic lymph node may be obtained with a combination of paraaortic lymp h node dissection and adjuvant radiotherapy or chemotherapy.