Radical Hysterectomy and Lymph Node Assessment

All patients underwent radical hysterectomy and bilateral pelvic lymphadenectomy with or without sentinel lymph node biopsy and salpingo-oophorectomy. Pre-operative staging was performed with a pelvic ultrasound scan, abdominal MRI-scan, and chest X-ray. The surgical approach was either laparotomy or minimally invasive (laparoscopy or robotic). The radicality of hysterectomy was classified according to the Querleu–Morrow classification [16 (link)]. In the case of suspicious initial parametrial involvement in the US-scan or MRI-scan, the patient was counseled for exclusive chemo-radiotherapy to be the first choice of treatment (as per ESGO guidelines [8 (link)]) or primary radical surgery, accepting the risk of potential adjuvant chemoradiation. A dedicated gynecologic oncology pathologist analyzed the surgical specimens. Adjuvant treatment was administered in line with international guidelines according to pathologic risk factors [8 (link)].