Objectives The purpose of this study was to identify patients with low-risk of parametrial involvement (PI) in early-stage cervical cancer potentially eligible for less radical surgery based on sentinel lymph node (SLN) status.

Methods We performed an ancillary analysis of data from two prospective trials on sentinel node biopsy for cervical cancer (SENTICOL I & II). Patients with FIGO IA-IIA cervical cancer treated with radical surgery and lymph node dissection, including SLN biopsy, were identified between 2005 and 2012 from 25 French oncologic centers. Patients who did not undergo radical surgery and patients who had preoperative brachytherapy were excluded.

Results Of 211 patients who fullfiled inclusion criteria, 11 patients (5.2%) had a pathological PI and 29 patients (13.7%) had positive SLN. The mean age was 43.2 years [22 – 85]. 160 patients had a radical hysterectomy (75.8%) and 59 a radical trachelectomy (24.2%). 86.1% of patients had stage IB1 disease. There were 68.9% epidermoid carcinomas and 28.6% adenocarcinomas. On multivariate analysis, PI was significantly associated with tumor size ≥ 20 mm at preoperative MRI (ORa = 5.75, 95%IC = [1.17–28.32], p =0.03) and positive sentinel lymph node (ORa = 9.59, 95%IC = [1.13–41.43], p =0.02).Of 114 patients with tumor smaller than 2 cm at preoperative MRI and negative SLN, only one had parametrial involvement (0.9%).

Conclusions Patients at low-risk of parametrial involvement may be safely selected with simple criteria. Less radical surgery associated with SLN biopsy may be a promising option for patients with tumor smaller than 2 cm and negative SLN.