OBJECTIVE: In this study, we aimed to describe the value of pelvic lymph node dissection (LND) after sentinel lymph node (SN) biopsy in early-stage cervical cancer. METHODS: We performed a retrospective multicenter cohort study in 8 gynecological oncology departments. In total, 645 women with International Federation of Gynecology and Obstetrics stage IA to IIB cervical cancer of squamous, adeno, or adenosquamous histologic type who underwent SN biopsy followed by pelvic LND were enrolled in this study. Radioisotope tracers and blue dye were used to localize the sentinel node, and pathologic ultrastaging was performed. RESULTS: Among the patients with low-volume disease (micrometastases and isolated tumor cells) in the sentinel node, the overall survival was significantly better (P = 0.046) if more than 16 non-SNs were removed. No such significant difference in survival was detected in patients with negative or macrometastatic sentinel nodes. CONCLUSIONS: Our findings indicate that in patients with negative or macrometastatic disease in the sentinel nodes, an additional LND did not alter survival. Conversely, our data suggest that the survival of patients with low-volume disease is improved when more than 16 additional lymph nodes are removed. If in a prospective trial our data are confirmed, we would suggest a 2-stage operation.

*Division of Woman and Baby Department of Gynaecological Oncology University Medical Center Utrecht Utrecht The Netherlands; †Department of Obstetrics and Gynecology Gynecological Oncology Centre 1st Faculty of Medicine and General University Hospital Charles University Prague; ‡Institute of Biostatistics and Analyses Masaryk University Brno Czech Republic; §Institut Claudius Regaud Toulouse; ∥Université Paris Descartes Sorbonne Paris Cité Assistance Publique Hôpitaux de Paris European Georges Pompidou Teaching Hospital Paris France; ¶Jagiellonian University Medical College Krakow Poland; University Hospital Ostrava Ostrava Czech Republic; and **Center for Gynaecologic Oncology Amsterdam VU University Medical Center Amsterdam The Netherlands

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