Radical parametrectomy after ‘cut-through’ hysterectomy in low-risk early-stage cervical cancer: Time to consider this procedure obsolete

Abstract

Objective: The goal of this study is to identify predictive factors in patients with a diagnosis of early-stage cervical cancer after simple hysterectomy in order to avoid a radical parametrectomy. Methods: A retrospective review was performed of all patients who underwent radical parametrectomy and bilateral pelvic lymphadenectomy at MD Anderson Cancer Center and at the Instituto de Cancerologia Las Americas in Medellin, Colombia from December 1999 to September 2017. We sought to determine the outcomes in patients diagnosed with low-risk factors (squamous, adenocarcinoma or adenosquamous lesions < 2 cm in size, and invading < 10 mm) undergoing radical parametrectomy and pelvic lymphadenectomy. Results: A total of 30 patients were included in the study. The median age was 40.4 years (range; 26–60) and median body mass index (BMI) was 26.4 kg/m2 (range; 17.7–40.0). A total 22 patients had tumors < 1 cm and 8 had tumors between 1 and 2 cm. A total of 6 (33%) of 18 patients had evidence of lymph-vascular invasion (LVSI). No radical parametrectomy specimen had residual tumor, involvement of the parametrium, vaginal margin positivity, or lymph node metastasis. None of the patients received adjuvant therapy. After a median follow-up of 99 months (range; 6–160) only one patient recurred. Conclusion: Radical parametrectomy may be avoided in patients with low-risk early-stage cervical cancer detected after a simple hysterectomy. Rates of residual disease (parametrial or vaginal) and the need for adjuvant treatments or recurrences are very low.