title: Can parametrectomy be avoided in early cervical cancer? An algorithm for the identification of patients at low risk for parametrial involvement.
abstract: OBJECTIVE
  To assess the rate of parametrial involvement in a large cohort of patients who underwent radical hysterectomy for cervical cancer and to suggest an algorithm for the triage of patients to simple hysterectomy or simple trachelectomy.
  
  
  METHODS
  Multicenter retrospective study of patients with cervical cancer stage I through IIA who underwent radical hysterectomy and pelvic lymphadenectomy. The patients were divided into 2 groups according to whether or not the parametrium was involved. The two groups were compared with regard to the clinical and histopathological variables. Logistic regression of the variables potentially assessable prior to definitive hysterectomy such as age, tumor size, lymph-vascular space invasion (LVSI) and nodal involvement was performed.
  
  
  RESULTS
  Five hundred and thirty patients had specific histological data on parametrial involvement and in 58 (10.9%) patients, parametria was involved. Parametrial involvement was significantly associated with older age, tumors larger than 2 cm, deeper invasion, LVSI, involved surgical margins, and the presence of nodal metastasis. By triaging patients with a tumor ≤ 2 cm and no LVSI, the parametrial involvement rate was 1.8% (2/112 patients). With further triage of patients with negative nodes, the rate of parametrial involvement was 0% (0/107 patients).
  
  
  CONCLUSIONS
  Using a pre-operative triage algorithm, patients with early small lesions, no LVSI and no nodal involvement may be spared radical surgical procedures and parametrectomy. Further prospective data are urgently needed.
authors.affiliation: Barzilai Medical Center, Ashkelon, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Gemer
authors.forename: R
authors.initials: R
authors.lastname: Eitan
authors.forename: M
authors.initials: M
authors.lastname: Gdalevich
authors.forename: A
authors.initials: A
authors.lastname: Mamanov
authors.forename: B
authors.initials: B
authors.lastname: Piura
authors.forename: A
authors.initials: A
authors.lastname: Rabinovich
authors.forename: H
authors.initials: H
authors.lastname: Levavi
authors.forename: B
authors.initials: B
authors.lastname: Saar-Ryss
authors.forename: R
authors.initials: R
authors.lastname: Halperin
authors.forename: S
authors.initials: S
authors.lastname: Finci
authors.forename: U
authors.initials: U
authors.lastname: Beller
authors.forename: I
authors.initials: I
authors.lastname: Bruchim
authors.forename: T
authors.initials: T
authors.lastname: Levy
authors.forename: I
authors.initials: I
authors.lastname: Ben Shachar
authors.forename: A
authors.initials: A
authors.lastname: Ben Arie
authors.forename: O
authors.initials: O
authors.lastname: Lavie
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007044:Hysterectomy; D016015:Logistic Models; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010388:Pelvis / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D014218:Triage; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*