Objective. In order to determine indications for less radical surgery such asmodified radical hysterectomy, the risk of pathological parametrial involvement and prognosis of FIGO stage IB1 cervical cancer patients undergoing standard radical hysterectomy with pre-operatively assessed tumor diameter ≤2 cm were investigated. Methods. We conducted a retrospective multi-institutional chart review of patients with FIGO stage IB1 cervical cancer who underwent primary surgical treatment between 1998 and 2002. The eligibility criteria for the analyses were (i) histologically-proven squamous cell carcinoma, adenocarcinoma or, adenosquamous cell carcinoma, (ii) radical hysterectomy performed, (iii) clinical tumor diameter data available byMR imaging or specimens by cone biopsy, and (iv) age between 20 and 70. Based on the clinical tumor diameter, patients were stratified into those with the following tumors: i) 2 cm or less (cT ≤ 2 cm) and ii) greater than 2 cm (cT > 2 cm).We expected 5-year OS of ≥95% and parametrial involvement <2-3% for patients with cT ≤ 2 cm who underwent radical hysterectomy. Results. Of the 1269 patients enrolled, 604 were eligible for the planned analyses. Among these, 571 underwent radical hysterectomy (323 with cT ≤ 2 cm and 248 with cT > 2 cm). Parametrial involvement was present in 1.9% (6/323) with cT ≤ 2 cm and 12.9% (32/248) with cT > 2 cm. Five-year overall survivals were 95.8% (95% CI 92.9-97.6%) in cT ≤ 2 cm and 91.9% (95% CI 87.6-94.8%) in cT > 2 cm patients. Conclusion. Patients with cT ≤ 2 cm had lower risk of parametrial involvement and more favorable 5-year overall survival. They could therefore be good candidates for receiving less radical surgery.
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