A 45-year-old woman with FIGO Stage IB3 cervical adenocarcinoma (5 cm, confined to cervix) is planned for radical hysterectomy. During surgery, a frozen section of a pelvic lymph node is positive for metastasis. What is the appropriate next surgical step?
- A Abandon hysterectomy, sample paraaortic nodes, and refer for chemoradiation ✓
- B Abandon hysterectomy and proceed to paraortic lymph node sampling
- C Complete the radical hysterectomy as planned
- D Perform a simple hysterectomy to reduce tumor burden
Correct answer: A. Abandon hysterectomy, sample paraaortic nodes, and refer for chemoradiation
Explanation
Intraoperative finding of positive pelvic lymph nodes upstages the disease to Stage IIIC1. Completing radical hysterectomy in this setting does not improve outcomes and adds morbidity. The standard approach is to abort the hysterectomy, sample paraaortic nodes to assess disease extent, and refer the patient for definitive concurrent chemoradiation with brachytherapy. This is based on the principle that surgery is not curative when lymph nodes are involved, and chemoradiation offers equivalent or better outcomes with less morbidity than surgery followed by adjuvant therapy.
Reference: Williams Gynecology, 4th ed.
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