Lymphadenectomy during radical hysterectomy for cervical cancer (stage IB 1-2, HA): state of the art.

Pelvic lymphadenectomy during radical hysterectomy in surgical candidates with cervical cancer (stage IBI-1, IIA) has become a standard method of therapy starting from mid 20th century. More knowledge about the natural history, predictive and prognostic factors of disease and effectiveness of surgical and adjuvant treatments of early stage cervical carcinoma has been accumulated over the past 5 decades. During the latter part of the 20th century the accumulating information base led to more conservative approaches for cancer resection in an effort to decrease the morbidity of radical surgery and to preserve the fertility if possible. Lymph node metastasis is a bad prognostic factor in the early stages of disease and automatically classifies a patient in a high-risk group necessitating adjuvant therapy. Preoperative diagnostic procedures, such as echotomography, computerized tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) and lymphangiography are all helpful in determining lymph node status, although their accuracy rate is anywhere between 57-85%. Recent studies of sentinel lymph nodes and lymph node topography are still very controversial and neither give information on the extent of lymphadenectomy needed nor help in patient selection in planning additional adjuvant therapy. Published results on laparoscopic lymphadenectomy demonstrate decreased postoperative morbidity, but still pose questions whether laparotomic lymphadenectomy should be replaced by this technique. Thus the question remains: how many lymph nodes, of which groups and by which technique should be dissected during pelvic lymphadenectomy?