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Surgical Treatment of Stage IB Cervical Cancer
  1. László Ungár, PhD*,
  2. László Pálfalvi, PhD*,
  3. László Tarnai, PhD,
  4. Valentina Nechushkina, PhD,
  5. Balázs Lintner, MD* and
  6. Zoltán Novák, PhD
  1. *Department of Obstetrics, Gynecology and Gynecologic Oncology, St. Stephen Hospital, Budapest, Hungary;
  2. Department of Obstetrics and Gynecology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary; and
  3. Department of Gynecology, N.N.Blokhin Russian Cancer Research Center, Moscow, Russian Federation.
  1. Address correspondence and reprint requests to László Ungár, PhD, St. Stephen Hospital, Nagyvárad Tér 1, Budapest, 1091, Hungary. E-mail: ungarl@t-email.hu.

Abstract

Introduction Recurrence originating from the pelvic lymph node containing fibro-fatty tissue has consistently been identified as the most frequent pattern of treatment failure in early-stage cervical cancer. A surgical technique for the complete removal of the connective tissue content of the pelvis was introduced at St. Stephen Hospital in 1993 to improve oncological outcome by reducing the risk of recurrence from the pelvis. Efficacy and toxicity of the procedure were studied in 563 patients with stage IB cervical cancer with a completed 5-year follow-up.

Methods Final pathology in 492 (87.4%) of 563 consecutive completed radical hysterectomies suggested that all tissue, which could contain tumor dissemination, was removed from the pelvis; thus, no adjuvant treatment was applied. Adjuvant chemoradiotherapy was advised in 71 cases (12.6%), where pathologic finding alluded tumor spread beyond the study criteria.

Finding At completed 5-year follow-up, the overall survival of 492 patients who had surgery without adjuvant therapy was 94.0%. Pathologic stage, lymphovascular space involvement, pelvic lymph node metastases, histology classification, and grade had no significant influence on prognosis. The only factor that influenced the overall survival was International Federation of Gynecology and Obstetrics stage (IB1 or IB2). Five-year overall survival of 71 patients to whom adjuvant therapy was recommended was 56.3%. Five-year overall survival of the whole cohort (n = 563) was 88.8%. The complication rate did not seem to be different from the published data on traditional radical surgery in cervical cancer.

Conclusions Our results (in accordance with other recent publications) suggest that complete excision of the connective tissue content of the pelvis provides equal or better survival chances without any adjuvant treatment for almost 90% of operable patients with stage IB cervical cancer than less radical surgery with or without adjuvant treatment. We suggest this strategy to be mentioned as one alternative in future treatment protocols.

  • Cervical cancer
  • Radical hysterectomy
  • Pelvic connective tissue clearance
  • Adjuvant treatment

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Footnotes

  • This study did not receive support from any institutions, including the National Institutes of Health, Wellcome Trust, and Howard Hughes Medical Institute.

  • The authors declare that there are no conflicts of interest.

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