title: Can radical parametrectomy be omitted in occult cervical cancer after extrafascial hysterectomy?
abstract: BACKGROUND
  Occult invasive cervical cancer discovered after simple hysterectomy is not common, radical parametrectomy (RP) is a preferred option for young women. However, the morbidity of RP was high. The aim of our study is to assess the incidence of parametrial involvement in patients who underwent radical parametrectomy for occult cervical cancer or radical hysterectomy for early-stage cervical cancer and to suggest an algorithm for the triage of patients with occult cervical cancer to avoid RP.
  
  
  METHODS
  A total of 13 patients with occult cervical cancer who had undergone RP with an upper vaginectomy and pelvic lymphadenectomy were included in this retrospective study. Data on the clinicopathologic characteristics of the cases were collected. The published literature was also reviewed, and low risk factors for parametrial involvement in early-stage cervical cancer were analyzed.
  
  
  RESULTS
  Of the 13 patients, 9 had a stage IB1 lesion, and 4 had a stage IA2 lesion. There were four patients with grade 1 disease, seven with grade 2 disease, and two with grade 3 disease. The median age of the entire patients was 41 years. The most common indication for extrafascial hysterectomy was cervical intraepithelial neoplasia 3. Three patients had visible lesions measuring 10-30 mm, in diameter and ten patients had cervical stromal invasions with depths ranging from 4 to 9 mm; only one patient had more than 50% stromal invasion, and four patients had lymph-vascular space invasion (LVSI). Perioperative complications included intraoperative bowel injury, blood transfusion, vesico-vaginal fistula, and ileus (1 case for each). Postoperative pathologic examination results did not show residual disease or parametrial involvement. One patient with positive lymph nodes received concurrent radiation therapy. Only one patient experienced recurrence.
  
  
  CONCLUSIONS
  Perioperative complications following RP were common, whereas the incidence of parametrial involvement was very low among selected early-stage cervical cancer patients. Based on these results, we thought that patients with very low-risk parametrial involvement(tumor size ≤ 2 cm, no LVSI, less than 50% stromal invasion, negative lymph nodes) may benefit from omitting RP. Further prospective data are warranted.
authors.affiliation: Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Guangzhou, Guangdong, 510120, P.R. China. luhuaiwu@163.com.
authors.forename: Huai-Wu
authors.initials: HW
authors.lastname: Lu
authors.affiliation: Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Guangzhou, Guangdong, 510120, P.R. China. ljlj_myy@163.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Guangzhou, Guangdong, 510120, P.R. China. 821681761@qq.com.
authors.forename: Yun-Yun
authors.initials: YY
authors.lastname: Liu
authors.affiliation: Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Guangzhou, Guangdong, 510120, P.R. China. hcl222@163.com.
authors.forename: Chang-Hao
authors.initials: CH
authors.lastname: Liu
authors.affiliation: Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Guangzhou, Guangdong, 510120, P.R. China. xuguocai1018@126.com.
authors.forename: Guo-Cai
authors.initials: GC
authors.lastname: Xu
authors.affiliation: Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Guangzhou, Guangdong, 510120, P.R. China. xielingling86@sina.com.
authors.forename: Ling-Ling
authors.initials: LL
authors.lastname: Xie
authors.affiliation: Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Guangzhou, Guangdong, 510120, P.R. China. rich192468@163.com.
authors.forename: Miao-Fang
authors.initials: MF
authors.lastname: Wu
authors.affiliation: Department of Gynecologic Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, Yanjiang Road West, Guangzhou, Guangdong, 510120, P.R. China. linzhongqiusysu@163.com.
authors.forename: Zhong-Qiu
authors.initials: ZQ
authors.lastname: Lin
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009382:Neoplasms, Unknown Primary; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms; D002578:Uterine Cervical Dysplasia