Is Radical Surgery or Parametrectomy Needed for Early-stage FIGO IA2 and Microscopic IB1 Cervical Cancer?

Although radical hysterectomy or radical trachelectomy with lymph node assessment are both considered a gold standard treatment for patients with cervical cancer stages IA2 and IB1, radical procedures (parametrectomy) are associated with an increased risk of morbidity and inferior quality of life as well as adverse obstetrical outcomes for radical trachelectomy. Moreover, prior studies demonstrated that in patients with favorable factors, such as: tumor size ≤2 cm, depth of stromal invasion <10 mm, and the absence of lymphovascular space, and negative pelvic nodes the risk of parametrial involvement is below 1%. The mounting evidence from retrospective and prospective studies (ConCerv trial) suggest that in those with a low risk of parametrial involvement simple surgery (conization, trachelectomy or hysterectomy) with lymph node assessment might be a safe alternative to the radical surgery (parametrectomy). It is expected that the results of two large prospective trials: GOG 278 and SHAPE will add to this debate in favor of “simple” surgery with lymph node assessment.