Para-aortic lymph node (PALN) status in locally advanced cervical cancer has therapeutic and prognostic implications.• Reported proportions in literature of upstaging by PALN dissection after negative PALN imaging were meta-analyzed.• After negative PET or PET-CT, PALN dissection yielded pathologic PALNs in 12% of all patients.• After negative MRI or CT, PALN dissection yielded pathologic PALNs in 11% of all patients.• After PET-CT showed pelvic nodal (but no PALN) involvement, PALN dissection yielded pathologic PALNs in 21% of patients.