The influence of surgical staging on the evaluation and treatment of patients with cervical carcinoma.

Ninety-six patients with cervical cancer underwent surgical staging prior to radiation therapy. An equal number of patients were explored by transperitoneal and extraperitoneal surgery. Three different extraperitoneal approaches were utilized. All patients had bilateral paraaortic lymphadenectomy and selective pelvic nodal sampling. Intraperitoneal cytology and selected biopsies were performed. A 52% correlation existed between clinical and surgical staging. Radiotherapeutic treatment decisions were subsequently based on findings at operative staging. Nine percent of patients undergoing transperitoneal staging experienced a small bowel injury after radiation requiring surgical correction. No patients undergoing extraperitoneal surgery experienced postradiation small bowel morbidity. Extended field radiation was administered to 17% of patients, and a 30% five-year disease-free survival rate was observed. Although prognostic stratification is enhanced with surgical staging, using current radiotherapy techniques, the majority of patients with paraaortic nodal metastases will fail treatment. Based on our experience, only 2.5% of patients in a Stage IIB-IVA category will benefit from radiotherapeutic treatment decisions made as a consequence of staging laparotomy.