The influence of pretreatment celiotomy and para-aortic lymphadenectomy on the management of advanced stage squamous cell carcinoma of the cervix.

Thirty patients with advanced stage squamous cell carcinoma of the cervix underwent exploratory celiotomy and para-aortic lymphadenectomy prior to beginning radiation therapy. Para-aortic lymph node metastases were found in 9 patients (30%), and visceral metastases in 2 patients (7%). Findings at celiotomy prior to initiation of therapy allowed patients to be divided into 3 groups: Patients with 1) visceral metastases, 2) para-aortic lymph node metastases but without visceral or scalene lymph node metastases, and 3) patients with disease confined to the pelvis. Therapy was then based on the extent of disease present in each patient. As a result of the surgical findings, 10 of 30 patients (33%) received therapy other than standard pelvic radiation therapy. The surgical technique, operative morbidity, and prognostic significance of the surgical findings are discussed.