Surgical treatment of patients with stages IB and IIA carcinoma of the cervix and palpably positive pelvic lymph nodes.

Review of the records of all patients undergoing radical hysterectomy for cervical cancer at our institution between 1956 and 1985 revealed 121 patients with stage IB or IIA lesions and metastasis to pelvic lymph nodes. A uniform part of our surgical practice is to record the findings from visual and palpatory examinations of the intra-abdominal and retroperitoneal structures at the beginning of the operative report. This information was available for 117 of 121 patients. Of these 117 patients, 51 (44%) had pelvic lymph nodes palpably involved with metastatic malignant disease at the time of exploration. The Kaplan-Meier estimate of 5-year disease-free survival for this group was 40% (median follow-up of disease-free patients was 20.5 years). Adjuvant pelvic radiotherapy was received by 29 of the 51 patients. The remaining 22 patients received no adjuvant treatment. Information on the sites of recurrence was available for 30 of 32 patients who had recurrence. The site of first recurrence included an extrapelvic component in 22 of the 30 (73%). Disease-free survival rates for these patients reflect the advanced nature of their tumors. In light of our experience and our current understanding of the relationship between radiotherapy dose, tumor volume, and efficacy, we regard the assertion that primary radiotherapy is preferable to surgery in this population to be counterintuitive, and we await with interest data demonstrating that disease-free survival with approaches that involve leaving macroscopic tumor on the pelvic sidewall is superior to that noted above.