Introduction/Background Fertility sparing treatments of cervical cancer have pushed the idea of overall cervical cancer surgical treatment perhaps becoming less radical due to low risk of parametrial involvement in patients with early stage I cervical tumors, and the benefit from parametrial resection being debatable. Determining factors predicting parametrial tumor spread and defining those at risk of recurrence still remain highly questionable.
Methodology We reviewed patients with stages IA2 and small IB1, who had all undergone radical hysterectomy with pelvic lymph node dissection treatment for cervical cancer, and analyzed factors contributing to parametrial cancer spread.
Results A total 980 patients treated for cervical cancer were reviewed, 279 with tumors smaller than 20 mm in diameter. Parametrial spread was detected in 10 patients (3.6%); 1.3% in parametrial lymph nodes, 1,8% in parametrial lymphovascular space, and0.9% as parametrial contiguous microscopic tumor spread. In 94.6% patients with negative pelvic nodes, none had parametrialnodal involvement, 0.9% had LVSI, and 0.4% had contiguous spread. Factors associated with parametrial disease were deep cervical invasion, lymphovascular space invasion (LVSI), tumor volume, and pelvic lymph node metastases. In patients without LVSI and superficial third tumor invasion, parametrial spread was identified in 0.5%.
Conclusion The risk of recurrence in 1 out of 200 patients still persists even in low risk small volume cervical cancer patients. Patients willing to accept this risk most likely as fertility sparing options must be clearly consented to this possibility of cancer recurrence which might likely be untreatable.
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