Timing and necessity of preserving external terminal iliac lymph nodes in early cervical cancer

Objective To summarize the metastasis of pelvic lymph nodes and external terminal iliac lymph nodes in early cervical cancer patients, and explore the time and necessity of preserving lymph nodes of the external iliac end in early cervical cancer surgery. Methods Retrospective analysis on clinical data of 537 patients with stage ⅠA-ⅡA early cervical cancer who underwent extensive hysterectomy and pelvic lymphadenectomy in the First Affiliated Hospital of Zhengzhou University from June 2014 to June 2017. Among them, 100 cases (18.6%) were stage ⅠA, 197 cases (36.6%) were stage ⅠB and 240 cases (44.7%) were stage ⅡA. Results Of the 537 patients, 123 cases (22.9%) had pelvic lymph node metastasis, 90 cases (16.8%) had obturator lymph node metastasis, 65 cases (12.1%) had internal and external iliac lymph node metastasis, 15 cases (2.8%) had common iliac lymph node metastasis, 6 cases (1.1%) had external iliac lymph node metastasis, and 10 cases (1.9%) had para-aortic lymph node metastasis. Six patients with positive lymph node metastasis in the external iliac end were stage ⅠB and ⅡA, and all of them were accompanied by other pelvic lymph node metastasis. Multivariate Logistic regression analysis showed that lymph-vascular space invasion and other pelvic lymph node metastasis were the influencing factors of lymph node metastasis at the external iliac end (P< 0.05). Conclusions The rate of lymph node metastasis in the external iliac end of early cervical cancer is very low. In order to reduce operative complications and improve the quality of life of patients, the preservation of lymph nodes in the external iliac end can be considered in patients with negative ⅠA phase or rapid frozen pathological examination during operation. Key words: Cervical cancer; Pelvic lymph nodes; External iliac lymph nodes; Metastasis pattern