Is it essential to perform complete paraaortic lymph node dissection if no metastases have been shown in the lower part of the aorta?

One hundred and twenty eight patients with cervical carcinoma underwent pretherapy staging laparotomy between the years 1991 and 1994. Adopting a transperitoneal approach nodal dissection was performed from the aortic bifurcation to the level of the renal artery. Specimens were segregated into those inferior to and superior to the origin of the inferior mesenteric artery (IMA) then sent for pathologic examination. Of the 15 histologically malign node samples inferior to the IMA, none were associated with neoplasia in the groups of node samples taken from above the IMA. Of the 5 malignant nodal samples taken from above the IMA, all had concurrent neoplastic changes in the specimens taken from below the IMA. An intraoperative complication rate of 8.7% was encountered in the lower nodal dissections. This was compounded by a resultant 7.7% complication rate with nodal dissection above the IMA. As a result of our findings we feel confident in omitting upper paraaortic lymph node (PALN) dissection in the absence of malignant findings in the inferior paraaortic lymph node at frozen section.