Identification of a Low-Risk Subset of Patients with Stage IB Invasive Squamous Cancer of the Cervix Possibly Suited to Less Radical Surgical Treatment

Because of the well-documented morbidity of radical hysterectomy, it would appear desirable to isolate a subset of patients at low risk of parametrial spread or disease recurrence who might thereby be candidates for less radical surgical therapy. To this end, the records of all patients undergoing r...

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Bibliographic Details
Published in:Gynecologic oncology 1995-04, Vol.57 (1), p.3-6
Main Authors: Kinney, Walter K., Hodge, David O., Egorshin, Edward V., Ballard, David J., Podratz, Karl C.
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Carcinoma, Squamous Cell - classification
Carcinoma, Squamous Cell - pathology
Carcinoma, Squamous Cell - surgery
Cervix Uteri - pathology
Cervix Uteri - surgery
Female
Female genital diseases
Follow-Up Studies
Gynecology. Andrology. Obstetrics
Humans
Hysterectomy - methods
Hysterectomy - standards
Life Tables
Lymph Node Excision
Lymphatic Metastasis
Medical sciences
Middle Aged
Morbidity
Neoplasm Staging
Proportional Hazards Models
Regression Analysis
Risk Factors
Tumors
Uterine Cervical Neoplasms - classification
Uterine Cervical Neoplasms - pathology
Uterine Cervical Neoplasms - surgery
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Summary:Because of the well-documented morbidity of radical hysterectomy, it would appear desirable to isolate a subset of patients at low risk of parametrial spread or disease recurrence who might thereby be candidates for less radical surgical therapy. To this end, the records of all patients undergoing radical hysterectomy for cervical carcinoma at our institution between 1956 and 1985 were reviewed. Of the 387 patients treated for squamous carcinoma clinically confined to the cervix, 83 (21.4%) had tumors with depth of invasion greater than 3 mm (stage IB) but volume of tumor less than or equal to that of a sphere 2 cm in diameter (4.19 cm3) and no tumor in angiolymphatic spaces. Of the 83 patients, none had parametrial nodal metastasis. Median follow-up of this subgroup was 9.8 years, and the Kaplan-Meier estimate of 5-year disease-free survival was 97.6% (95% confidence interval, 94.3-100%). We consider patients in the subset described above to be candidates for modified radical hysterectomy and pelvic lymphadenectomy, with a decrease in morbidity associated with the less radical dissection, a low risk of failure to excise occult parametrial tumor, and the expectation of an excellent chance of long-term disease-free survival.
ISSN:0090-8258
1095-6859
DOI:10.1006/gyno.1995.1091