Parametrial involvement in women with low-risk, early-stage cervical cancer

Abstract

This study identified the incidence of parametrial involvement in low risk, early-stage cervical cancer patients and evaluated the factors associated with parametrial involvement. All stage IA2-IB1 cervical cancer patients who underwent radical hysterectomy with pelvic lymphadenectomy were retrospectively reviewed. Patients with squamous cell carcinoma or adenocarcinoma grade 1-2, tumour size less than 2 cm, no lymphovascular space invasion (LVSI), negative pelvic nodes and depth of stromal invasion (DSI) less than 10 mm were identified as the low-risk group. A total of 243 patients were eligible. Squamous cell carcinomas were the most frequent histological cell type (65%). Most patients (81.5%) had tumour size less than 2 cm. Thirteen patients (5.3%) had parametrial involvement, 77 (31.7%) had DSI more than 10 mm, 121 (49.8%) had more than 50% invasion, 119 (49%) had LVSI and 19 (7.5%) had node metastasis. Ninety-five patients (39.1%) were defined as low risk. None of low-risk group had parametrial involvement. DSI more than 10 mm or more than 50% stromal invasion, presence of LVSI and pelvic node metastasis were significant factors associated with parametrial involvement. Parametrial involvement in low-risk, early-stage cervical cancer is extremely low. Less radical surgery may be an alternative treatment option.

Fertility‐sparing surgery for early‐stage cervical cancer: A case series study on the efficacy and feasibility of cervical conization followed by pelvic lymphadenectomy

“…Therefore, radical resection of the parametrium is essential in surgical procedures for advanced‐staged cervical cancer 35–37 . By contrast, the indication for nonradical surgery for early‐stage cervical cancer, which is less likely to have parametrial involvement, has been discussed recently 24,38,39 . Importantly, several studies have investigated the risk factors for parametrial to improve the selection of candidates for nonradical surgery.…”

“…Importantly, several studies have investigated the risk factors for parametrial to improve the selection of candidates for nonradical surgery. As a result, histopathological findings, such as large tumor size (≥2 cm), presence of LVSI, and deep stromal invasion (≥10 mm or ≥50%), were considered the predictive factors for parametrial involvement 35,39 . Thus, the histopathological evaluation of risk factors for predicting parametrial involvement are essential when considering the indications for cervical conization combined with pelvic lymphadenectomy as a fertility‐sparing procedure.…”

“…Meanwhile, the NCCN guidelines showed that patients diagnosed with stage IB1 disease via cervical conization are considered candidate for radical trachelectomy with pelvic lymphadenectomy 13 . However, accumulating evidence showed that 45%–60% of patients who undergo radical trachelectomy had no residual disease based on the evaluation of surgical specimens 24,36,39–41 . Therefore, the range of indications for cervical conization combined with pelvic lymphadenectomy as a fertility‐sparing treatment for well‐selected patients with early‐stage cervical cancer may be expanded.…”

“…[35][36][37] By contrast, the indication for nonradical surgery for early-stage cervical cancer, which is less likely to have parametrial involvement, has been discussed recently. 24,38,39 Importantly, several studies have investigated the risk factors for parametrial to improve the selection of candidates for nonradical surgery. As a result, histopathological findings, such as large tumor size (≥2 cm), presence of LVSI, and deep stromal invasion (≥10 mm or ≥50%), were considered the predictive factors for parametrial involvement.…”

“…13 However, accumulating evidence showed that 45%-60% of patients who undergo radical trachelectomy had no residual disease based on the evaluation of surgical specimens. 24,36,[39][40][41] Therefore, the range of indications for cervical conization combined with pelvic lymphadenectomy as a fertility-sparing treatment for well-selected patients with early-stage cervical cancer may be expanded. Taken together, clinical data from the current study and previous reports indicated collectively that decisionmaking regarding the indications for cervical conization followed by pelvic lymphadenectomy or radical trachelectomy should be based on the rigorous histopathological assessment of cervical conization specimens and the evaluation of predictive risk for parametrial involvement.…”