Cervical cancer arises from the neck of the womb (cervix). Cervical screening programmes have decreased the rate of advanced cervical cancer. However, a significant number of cases still present with locally advanced disease that involves large cervical tumours ( > 4cm) or tumours that extend to the upper vagina. The larger the primary tumour, the greater the likelihood of metastasis (spread of cancer to other areas of the body). Cervical cancer spreads to the lymph nodes in the pelvis and around the aorta (one of the major blood vessels in the abdomen). Stage is a standardised assessment of the size of the cancer and if it has spread to adjacent or distant sites. Stage for stage, women with para-aortic lymph node metastases at presentation have a lower survival than those who do not have para-aortic metastases at presentation.
Accurate detection of involved para-aortic lymph nodes helps to tailor radiotherapy so that it includes this area (extended field radiotherapy). It also provides prognostic information. Different methods have been used to detect para-aortic lymph node metastases including surgical and radiological (various types of x-rays) techniques, however it is unclear which is more accurate.
The purpose of this review was to assess the available literature on the effectiveness and safety of pre-treatment surgical para-aortic lymph node assessment for locally advanced cervical cancer. We found only one randomised controlled trial (RCT) that assessed non-surgical staging versus surgical staging. We found limited evidence that suggested that clinical staging may offer a survival benefit (in terms of overall and progression-free survival) compared with surgical staging, but the strength of the evidence from this small trial is weak and the trial was at moderate risk of bias. There was no statistically significant difference in any of the reported outcomes between two surgical staging techniques examined in the trial.
Due to the small number of patients with locally advanced cervical cancer in only one included trial there was insufficient evidence to conclude that any of the staging techniques are superior to each other. This review highlights the need for future good quality, well designed trials which report not only survival and severe adverse event outcomes but also examine quality of life (QoL) outcome data.