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.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.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.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.NCT04037124.
