PRETREATMENT LYMPHANGIOGRAPHY AND OPERATIVE EVALUATION IN CARCINOMA OF THE CERVIX

Ninety-five patients with cervical carcinoma who were not candidates for definitive operation underwent initial lymphatic and 24-hour nodal phase lymphangiography and lymphadenectomy prior to radiation therapy. Operation by a transperitoneal or extraperitoneal approach consisted of bilateral pelvic and periaortic lymphadenectomy, exploratory laparotomy, and intraperitoneal biopsies as indicated by the findings. Radiation therapy was modified to include proved sites of metastases. Intestinal injuries followed transperitoneal operation and radiation therapy but were uncommon in patients in whom exploration was done by the extraperitoneal route. Eighteen patients (19%) had unsuspected metastases to common iliac or periaortic lymph nodes identified at operation. The characteristics of the primary tumor and the interpretation of the lymphangiogram provided an inaccurate basis on which to modify treatment. As further studies confirm the risk of disseminated disease in those patients with metastases to common iliac and periaortic lymph nodes, future treatment plans might incorporate adjuvant chemotherapy or immunotherapy in addition to extended-field irradiation. © 1979.