Background: Cervical cancer is the second most frequently diagnosed
cancer and the third leading cause of cancer death for women in developing
countries. Radical hysterectomy with bilateral pelvic lymph node dissection is
usually preferred for patients with stage IB1-IIA2 disease. Currently, imaging
has certain limitations in the diagnosis of lymph node metastasis, and the
accuracy of detection remains unsatisfactory. Indeed, only pathological
examination after removal of the suspected metastatic lymph nodes during surgery
can conclusively identify the presence of metastasis. Furthermore, if a lymphatic
metastasis is detected, there are no clear guidelines regarding whether to
complete radical surgery or to conduct a systematic lymphadenectomy followed by
adjuvant concurrent chemoradiotherapy. This retrospective study aimed to compare
the efficacy and safety of the two treatment modalities in this patient
population. Methods: Forty-nine stage IB1-IIA2 cervical cancer patients
with lymphatic metastasis confirmed by systematic pelvic and para-aortic lymph
node dissection from 2007 to 2018 were reviewed. The patients were treated with
either primary chemoradiation or radical hysterectomy followed by adjuvant
chemoradiation after lymphadenectomy. Survival states and adverse events of the
two treatments were compared. Results: The median follow-up time was 45
(range 11–119 months) months. In the non-radical surgery group, one patient
(1/15, 6.7%) relapsed and died, while in the radical surgery group, seven
patients (7/27, 25.9%) relapsed and five (5/27, 18.5%) died. A significant
difference was found in the mean progression-free survival (PFS) between the two
groups, which was 69 (95% confidence interval 49.118–88.882) months in the
non-radical surgery group and 44 (95% confidence interval 35.857–52.143) months
in the radical surgery group (p
