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In Japan, the standard treatment approach for women with early-stage cervical cancer includes a radical hysterectomy with bilateral pelvic lymphadenectomy for stage IB–IIB disease [1]. A benefit of surgery is that exploration allows surgeons to have an opportunity to assess the para-aortic lymph nodes (PANs) for metastasis. A recent survey study has shown that nearly 60% of Japanese Gynecologic Oncology Group (JGOG) institutions perform para-aortic lymphadenectomy for early-stage cervical cancer but there is a lack of universal indications for this procedure across their institutions [2].

Quality and quantity metrics of pelvic lymph node metastasis and risk of para-aortic lymph node metastasis in stage IB–IIB cervical cancer