BACKGROUND: The management of cervical cancer patients with intraoperative detection of lymph node involvement remains controversial. Since all these patients are referred for (chemo)radiation after the surgery, the key decision is whether radical hysterectomy should be completed as originally planned, taking into account an additional morbidity associated with extensive surgical dissection prior to adjuvant treatment. The ABRAX study investigated whether completing a radical uterine procedure is associated with an improved oncological outcome of such patients. PATIENTS AND METHODS: We performed retrospective analyses of 515 cervical cancer patients (51 institutions, 19 countries) who were referred for primary curative surgery between 2005 and 2015 (stage IA-IIB, common tumour types) in whom lymph node involvement was detected intraoperatively. Patients were stratified according to whether the planned uterine surgery was completed (COMPL group, N = 361) or abandoned (ABAND group, N = 154) to compare progression-free survival. Definitive chemoradiation was given to 92.9% patients in the ABAND group and adjuvant (chemo)radiation or chemotherapy to 91.4% of patients in the COMPL group. RESULTS: The risks of recurrence (hazard ratio [HR] 1.154, 95% confidence intervals [CI] 0.799-1.666, P = 0.45), pelvic recurrence (HR 0.836, 95% CI 0.458-1.523, P = 0.56), or death (HR 1.064, 95% CI 0.690-1.641, P = 0.78) were not significantly different between the two groups. No subgroup showed a survival benefit from completing radical hysterectomy. Disease-free survival reached 74% (381/515), with a median follow-up of 58 months. Prognostic factors were balanced between the two groups. FIGO stage and number of pelvic lymph nodes involved were significant prognostic factors in the whole study cohort. CONCLUSION: We showed that the completion of radical hysterectomy does not improve survival in patients with intraoperatively detected lymph node involvement, regardless of tumour size or histological type. If lymph node involvement is confirmed intraoperatively, abandoning uterine radical procedure should be considered, and the patient should be referred for definitive chemoradiation. CLINICAL TRIALS IDENTIFIER: NCT04037124.

1st Obstetrics and Gynecology Clinic University of Medicine and Pharmacy Targu Mures Targu Mures Romania

Cannizzaro Hospital Catania Italy

Comprehensive Oncology Gynecology Operational Unit Fondazione Policlinico Gemelli IRCCS Rome Italy

Department of Gynaecology and Obstetrics Medical University Hannover Hannover Germany

Department of Gynecologic Oncology Saglik Bilimleri University Antalya Research and Training Hospital Antalya Turkey

Department of Gynecological Surgery National Institute of Neoplastic Diseases Lima Peru

Department of Gynecology and Obstetrics Faculty of Medicine Masaryk University Brno Czech Republic

Department of Gynecology and Obstetrics University Hospital Leuven Leuven Cancer Institute Leuven Belgium

Department of Gynecology and Reproductive Medicine Jena University Hospital Friedrich Schiller University Jena Germany

Department of Gynecology National Institute of Oncology Budapest Hungary

Department of Obstetrics and Gynecology District Hospital Altotting Altotting Germany

Department of Obstetrics and Gynecology Skåne University Hospital Lund Faculty of Medicine Clinical Sciences Lund University Sweden

Department of Obstetrics and Gynecology University Hospital Ostrava Ostrava Poruba Czech Republic

Fondazione IRCCS Instituto Nazionale Tumori Milan Italy

Gynecologic Oncology Center Department of Obstetrics and Gynecology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Gynecologic Oncology Department Barretos Cancer Hospital Barretos Brazil

Gynecology Cancer Center St Franzis Hospital Munster Munster Germany

Gynecology Oncology Center National Institute of Cancerology Mexico Mexico

Gynecology Oncology Department Institute of Cancerology Las Americas Clinic Medellin Medellin Colombia

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic

National Institute of Cancerology Bogotá Professor Universidad Pontificia Bolivariana Medellín Colombia

Northern Gynaecological Oncology Centre Queen Elizabeth Hospital Gateshead United Kingdom

Unit of Gynaecological Oncology Institute Clinic of Gynaecology Obstetrics and Neonatology Barcelona Spain

University Clinic Frankfurt Goethe University Frankfurt Germany

University Medical Center Hamburg Eppendorf Hamburg Germany

References provided by Crossref.org

Magnetic resonance imaging and ultrasound examination in preoperative pelvic staging of early-stage cervical cancer: post-hoc analysis of SENTIX study

Consensus on surgical technique for sentinel lymph node dissection in cervical cancer

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NCT04037124