Feasibility of less radical surgery for superficially invasive carcinoma of the cervix

Abstract

Objective: To determine the incidence of parametrial involvement in patients with superficially invasive cervical cancer and to assess the feasibility of less radical surgery in this subset of patients.

Patients and methods: A retrospective analysis was performed in 375 patients with stage IB1 cervical cancer who underwent radical surgery at Seoul National University Hospital from 2000 to 2008. Parametrial involvement in patients with invasion ≤5 mm was the primary outcome of this study. In addition, the differences in pathologic variables according to the depth of invasion (≤5 vs. >5 mm) were evaluated using chi-square test or Fisher's exact test. Survivals were also estimated using Kaplan-Meier method and log-rank test.

Results: During the study period, 140 cases with invasion ≤5 mm were identified. Mean depth of invasion was 3.30±1.36 mm, and mean diameter of width was 16.6±7.5 mm (range, 2-36 mm). None of these patients had parametrial involvement. However, lymph node metastasis was present in 5 patients (3.6%). In contrast, among patients with invasion >5 mm, parametrial invasion and lymph node metastasis were present in 36 (15.3%) and 54 patients (23.0%), respectively. 5-year disease-free survival in patients with invasion≤5 mm was 97.5%, which was significantly better than 87.3% in patients with invasion>5 mm (P=0.002).

Conclusion: We have demonstrated that stage IB1 patients with depth of invasion≤5 mm are at very low risk for parametrial involvement. These low-risk patients could be candidates for prospective clinical trials on less radical surgery omitting parametrectomy.