The potential of less radical surgery without parametrectomy. Are we safe?

Aim: The aim of this study is to evaluate whether omission of parametrial removal in low risk patients with early stage cervical cancer is safe, taking into account the favorable prognostic characteristics that are usually used in recent studies debating a more conservative treatment in such patients.

Methods: A comprehensive search conducted in PubMed and MEDLINE databases.

Results: In low risk patients with favorable prognostic factors such as tumor size ≤2 cm, depth of stromal invasion ≤10 mm and no LVSI, there are 5% of patients having positive pelvic lymph nodes. Although parametrial involvement is associated with positive pelvic lymph node metastasis, there are studies which report patients with negative pelvic lymph node involvement with parametrial metastases. This indicates that although negative pelvic lymph nodes in low risk patients is a favorable criterion among of those previously reported for conservative treatment, does not eliminate the possibility of parametrial involvement.

Conclusions: Although specific favorable prognostic characteristics may indicate less radical treatment for low risk patients with early stage cervical cancer, more research is needed to estimate the risk of parametrial involvement in low risk patients without pelvic node involvement.