Author reply

I thank Drs. Barranger and Darai for their response to my editorial.1 They have highlighted a number of important points with respect to technical aspects of pericervical injections.

However, the 95% confidence intervals produced in my editorial were based on data from 13 patients in their article. For them to produce updated information on 25 patients is irrelevant to my critique of their report, and they may wish to submit another article at a later date.

The issue of the number of lymph nodes still is relevant. According to their methodology, both the external iliac lymph nodes and the obturator lymph nodes were removed systematically at pelvic lymphadenectomy. In the study quoted by the authors (Atlan et al.2), I saw no quantification of the number of lymph nodes removed at surgery. Furthermore, the study quoted was a retrospective evaluation of 414 patients who underwent radical hysterectomy with either preoperative or postoperative adjuvant radiation therapy, and therefore it is unlikely to be truly representative of a typical surgical population. That is, when it is known that the patient will receive postoperative pelvic irradiation, the zeal with which the surgeon removes the pelvic lymph nodes likely is diminished.

Finally, although I am optimistic that sentinel lymph node mapping will find a role in the management of patients with cervical carcinoma, currently, I must disagree with the authors' final statement that “a laparoscopic approach associated with lymphatic mapping permits a reduction in the aggressiveness of surgical management.” Currently, it can be stated only that it may permit a reduction in the amount of surgery required for patients with cervical carcinoma.

Allan Covens M.D.*, * Toronto Sunnybrook Cancer Center, University of Toronto, Toronto, Ontario, Canada.