Publication:

Occult parametrial metastasis in operable cancer cervix: is a routine radical hysterectomy justified?

Background Operable Ca cervix is treated by a Type III Radical hysterectomy(RH) with pelvic lymphadenectomy and comprises of a complex parametrial resection (PR) due to the possibility of occult parametrial metastasis(OPM) leading to high post-operative and delayed morbidity especially after adjuvant radiotherapy(RT). If risk factors for OPM were known, a less radical procedure could be performed in low risk patients thus minimizing the morbidity.

Methods A retrospective study was carried out to evaluate the incidence of OPM in operated patients and to study the risk factors associated with OPM and explore the theoretical feasibility of doing a type I hysterectomy in low risk patients.

Results The incidence of OPM was 16.1% in all stages (0% in IA, 10.71% in IB1, 33.3% in Stage IB2 and 18.8 % in IIA1). Primary tumor diameter (PTD) and LNM were the most statistically significant risk factors for OPM. 90% of patients with OPM also had lymph node metastasis (LNM). In this study, all patients with OPM had other risk factors for adjuvant treatment.

Conclusions Small size early stage tumors may be considered for less radical surgery in the absence of obvious intermediate risk factors. A node dissection with negative frozen section during surgery can finally select patients for a simple hysterectomy(SH). More evidence from randomized trials are needed to evaluate the oncological safety of a less radical procedure and define the type of surgery to be done.