Tailoring the parametrectomy in stages IA2-IB1 cervical carcinoma: is it feasible and safe?
OBJECTIVE
Several authors have proposed the use of a less aggressive surgery (i.e., modified or type 2 radical hysterectomy) for patients affected by early stages cervical carcinoma. However, little attention has been given to the evaluation of adverse prognostic factors before selecting the surgical approach. The aim of this study is to evaluate the feasibility and safety of tailoring parametrectomy on the basis of specific prognostic factors preoperatively assessed.


METHODS
Patients with cervical carcinoma FIGO IA2-IB1 entered the study. Eligibility criteria were: age < 75 years, no contraindications for surgery, informed consent, expected cooperation for follow-up. Tumor size was preoperatively assessed by pelvic examination under anesthesia and pelvic MRI. Patients were submitted to systematic lymphadenectomy of superficial obturator, external iliac, and interiliac nodes by laparotomy or laparoscopy. Lymph nodes were sent for frozen section. Node-negative patients were submitted to modified radical hysterectomy (type 2). Patients with nodal metastases underwent classical radical hysterectomy (types 3-4) and systematic pelvic and aortic node dissection up to the inferior mesenteric artery. Survival rates were calculated using the Kaplan-Meier product-limit method.


RESULTS
Eighty-three patients were enrolled in the study. Among these, 63 patients were node-negative at frozen section, and therefore submitted to modified radical hysterectomy (Group A); 20 patients were found having nodal metastases intra-operatively, and therefore submitted to classical radical hysterectomy (Group B). Median follow up was 30 months. Five years overall survival was 95% for Group A, and 74% for Group B.


CONCLUSIONS
Pre-treatment evaluation of adverse prognostic factors in patients affected by cervical cancer FIGO stages IA2-IB1 is feasible and mandatory to determine if a less radical surgery is applicable and safe.
Panici
Pierluigi Benedetti
PB
Department of Obstetrics and Gynecology, "La Sapienza" University, Viale Regina Elena 324, 00168 Rome, Italy. p.panici@unicampus.it
Angioli
Roberto
R
Palaia
Innocenza
I
Muzii
Ludovico
L
Zullo
Marzio Angelo
MA
Manci
Natalina
N
Rabitti
Carla
C
D018572:Disease-Free Survival; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D010865:Pilot Projects; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*