Is Radical Hysterectomy Necessary in Early Cervical Cancer?

Abstract

Aims: To estimate the prevalence of tumor spread to the parametrium, vagina and uterine corpus in radical hysterectomy specimens and define a subgroup of patients with low-risk of extracervical involvement, who may benefit from less radical surgery. Methods: We retrospectively reviewed 96 patients with stage IA1-IIA cervical cancer who had undergone radical hysterectomy and pelvic lymphadenectomy. Results: Tumor spread beyond the uterine cervix was evident in 45 (47%) patients. Thirteen (13%) of the 96 patients had parametrial tumor spread, 12 (13%) had vaginal tumor extension, and 23 (24%) had uterine corpus involvement. Tumor size >2 cm, stromal invasion to a depth of ≥8 mm, and lymph vascular space invasion (LVSI) were significantly associated with extracervical invasion. Twenty-five patients had stromal invasion of <8 mm and no LVSI, of which only 1 (4%) had extracervical involvement. On the contrary, extracervical involvement was evident in 44 patients (63%) among those who had stromal invasion of ≥8 mm and/or LVSI (p < 0.001). Among women with LVSI, extracervical tumor spread was seen with any tumor size and any depth of stromal invasion. All patients with stromal invasion to a depth of >15 mm had extracervical invasion. Conclusion: Patients with tumor size <2 cm, depth of invasion of <8 mm and no LVSI could be considered for less radical surgery.

Total Laparoscopic Nerve-Sparing Radical Parametrectomy for Occult Early-Stage Cervical Cancer: Surgical Technique and Postoperative Bladder Function

“…After the laparoscopic radical parametrectomy we performed, the pathology analysis revealed no residual tumor, enabling us to determine that the disease was early-stage and that we could avoid radiotherapy, which would likely have been overtreatment. Meirovitz et al [11] described that cervical cancer patients with tumor size <2 cm, depth of invasion <8 mm and no lymphovascular space invasion could be considered for less radical surgery, therefore the laparoscopic radical parametrectomy for this case could also be overtreatment; however, this is still controversial.…”

A Multicenter Study of the Importance of Systemic Chemotherapy for Patients with Small-Cell Neuroendocrine Carcinoma of the Uterine Cervix

“…Thus, even though the worldwide accepted treatment for patients with early cervical cancer is radical hysterectomy with pelvic lymphadenectomy [26,27], early-stage SCNEC requires systemic chemotherapy as part of the initial treatment along with surgery or radiation. Clinical trials are warranted to confirm the appropriate regimen and schedule of chemotherapy to improve the survival of patients with SCNEC.…”

Uterine Prolapse Complicated by Vaginal Cancer: A Case Report and Literature Review

“…This is mainly due to the concern with morbidity and quality of life, and the trend for more individualization of treatment [13]. In China, the quality of life of cancer patients has increasingly been attracting attention from clinical doctors and healthcare professionals [14].…”