Patterns of lymph node involvement and role of common iliac lymphadenectomy in early-stage cervical cancers: A retrospective analysis from tertiary care cancer center in Eastern India

Aims: The aim of the study was to analyze the patterns of lymph node metastasis in early cervical cancer cases operated and to measure the metastatic burden in common iliac nodes and subsequently assess the need for its dissection. Materials and Methods: The study included all the cases of early carcinoma of cervix (Stage IA to IIA) that were operated in our institute. The cases with positive (metastatic) lymph nodes were isolated incorporating the data in tabular form and the patterns of lymph node metastasis analyzed with special reference to common iliac node involvement. Results: A total of 250 patients were operated in our study cohort and 50 cases (20%) had positive lymph node metastasis. External iliac nodes (58%) were most commonly involved, whereas 20% of cases had common iliac nodal involvement and isolated common iliac nodal involvement was seen only in 8% of these cases. Among all the lymph node positive cases, 74% had two or more of the three intermediate-risk factors including deep stromal invasion, lymphovascular space invasion positivity, or large-sized lesion (>4 cm). All the isolated common iliac lymph node positive cases had either positive parametrium or at least two intermediate-risk factors. Conclusion: Isolated common iliac nodal involvement being very low (8%), and this isolated involvement having been demonstrated only in cases with other risk factors; the role of common iliac lymph node dissection in early-stage cancer cervix becomes questionable.