Surgical nodal staging in cervical cancer, a narrative review from the French cervical cancer guidelines group
Abstract
Objective: To synthesize contemporary evidence on surgical lymph-node staging in cervical cancer especially its indications, techniques, extent, morbidity, and impact on oncologic outcomes. Background: Nodal status is a key prognostic factor that guides treatment decisions and radiotherapy field planning. While 18F-FDG PET/CT is the imaging reference, false-negative rates for para-aortic disease remain clinically relevant, especially when pelvic nodes are positive, motivating selective surgical staging. Methods: We conducted a narrative review of published studies investigating the prognostic and therapeutic impact of pelvic and/or para-aortic lymph-node assessment, including sentinel lymph-node (SLN) mapping in patients with cervical cancer. Results: In early-stage disease, SLN mapping achieves high overall and bilateral detection, enables ultrastaging to uncover micrometastases and isolated tumor cells, and reduces morbidity compared with systematic pelvic lymphadenectomy while maintaining oncologic safety in contemporary series and trials. Survival advantages of surgical over imaging-only staging remain heterogeneous across studies. In locally-advanced cancers, surgical para-aortic staging identifies occult metastases in roughly one in ten patients with negative para-aortic PET/CT and in a higher proportion when pelvic nodes are PET-positive, often leading to adaptation of chemoradiation fields but the effect on survival remain debated. Minimally invasive extraperitoneal and transperitoneal approaches provide comparable node yields and similar timelines to chemoradiation, with low severe morbidity in experienced centers. Extending dissection from infra-mesenteric to infra-renal increases node counts but data regarding identification of additional lymph node metastasis are inconsistent. Conclusions: Surgical staging refines the assessment of lymph node involvement and enables appropriate tailoring of chemo-radiotherapy fields to include the para-aortic area when indicated. Standardized reporting of technique, extent, and downstream radiotherapy is needed.
Related
- FERTILITY-SPARING SURGERY AND OVARIAN TRANSPOSITION IN CERVICAL CANCER - A REVIEW FROM THE FRENCH CERVICAL CANCER GUIDELINES GROUP
- CERVICAL CANCER: NATIONAL CLINICAL PRACTICE GUIDELINES FROM THE FRENCH CERVICAL CANCER GUIDELINES GROUP
- ASSESSMENT OF TREATMENT RESPONSE RESPONSE AND THE ROLE OF COMPLETION SURGERY AFTER CONCURRENT CRTAND BRACHYTHERAPY FOR LOCALLY ADVANCED CERVICAL CANCER - A REVIEW FROM THE FRENCH CERVICAL CANCER GUIDELINES GROUP
- POST-TREATMENT SURVEILLANCE AND MANAGEMENT OF RECURRENT CERVICAL CANCER - A REVIEW FROM THE FRENCH CERVICAL CANCER GUIDELINES GROUP
- CT radiomics-histopathological correlation for mediastinal lymph node staging in non-small cell lung cancer
BibTeX
@article{dabi2026surgical,
title = {{Surgical nodal staging in cervical cancer, a narrative review from the French cervical cancer guidelines group}},
author = {Yohann Dabi and Alejandra Martinez and Aymeline Lacorre and Cyril Touboul and Thomas Gaillard and Vincent Lavoué and Enora Laas and Henri Azaïs},
journal = {Journal of Gynecology Obstetrics and Human Reproduction},
year = {2026},
month = oct,
doi = {10.1016/j.jogoh.2026.103260},
url = {https://hal.science/hal-05749466v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Surgical nodal staging in cervical cancer, a narrative review from the French cervical cancer guidelines group
AU - Yohann Dabi
AU - Alejandra Martinez
AU - Aymeline Lacorre
AU - Cyril Touboul
AU - Thomas Gaillard
AU - Vincent Lavoué
AU - Enora Laas
AU - Henri Azaïs
PY - 2026
DA - 2026/10/23
JO - Journal of Gynecology Obstetrics and Human Reproduction
DO - 10.1016/j.jogoh.2026.103260
UR - https://hal.science/hal-05749466v1
AB - Objective: To synthesize contemporary evidence on surgical lymph-node staging in cervical cancer especially its indications, techniques, extent, morbidity, and impact on oncologic outcomes. Background: Nodal status is a key prognostic factor that guides treatment decisions and radiotherapy field planning. While 18F-FDG PET/CT is the imaging reference, false-negative rates for para-aortic disease remain clinically relevant, especially when pelvic nodes are positive, motivating selective surgical staging. Methods: We conducted a narrative review of published studies investigating the prognostic and therapeutic impact of pelvic and/or para-aortic lymph-node assessment, including sentinel lymph-node (SLN) mapping in patients with cervical cancer. Results: In early-stage disease, SLN mapping achieves high overall and bilateral detection, enables ultrastaging to uncover micrometastases and isolated tumor cells, and reduces morbidity compared with systematic pelvic lymphadenectomy while maintaining oncologic safety in contemporary series and trials. Survival advantages of surgical over imaging-only staging remain heterogeneous across studies. In locally-advanced cancers, surgical para-aortic staging identifies occult metastases in roughly one in ten patients with negative para-aortic PET/CT and in a higher proportion when pelvic nodes are PET-positive, often leading to adaptation of chemoradiation fields but the effect on survival remain debated. Minimally invasive extraperitoneal and transperitoneal approaches provide comparable node yields and similar timelines to chemoradiation, with low severe morbidity in experienced centers. Extending dissection from infra-mesenteric to infra-renal increases node counts but data regarding identification of additional lymph node metastasis are inconsistent. Conclusions: Surgical staging refines the assessment of lymph node involvement and enables appropriate tailoring of chemo-radiotherapy fields to include the para-aortic area when indicated. Standardized reporting of technique, extent, and downstream radiotherapy is needed.
SN - 2468-8495
SN - 2468-7847
ER -