Conservative management of early stage cervical cancer: is there a role for less radical surgery?

OBJECTIVES: The utility of parametrial resection in women with early stage cervical cancer is controversial. In patients with favorable pathologic characteristics such as tumor size <2cm and the absence of lymphovascular space invasion, the rate of parametrial involvement is very low. More conservative surgical approaches have therefore been suggested. The objective of this report is to review the existing literature in this area and to describe an ongoing prospective study evaluating the safety and efficacy of conservative surgery in women with early stage cervical cancer.

METHODS: We performed a search of PubMed for English language articles published between 1970 and 2010 using the MeSH terms "cervical cancer", "conservative surgery", and "cone biopsy".

RESULTS: Several retrospective studies have shown that <1% of patients with early stage cervical cancer with favorable pathologic characteristics have parametrial involvement. In addition, approximately 60% of patients undergoing radical trachelectomy have no residual disease in the final pathologic specimen. Recent studies have reported on the feasibility and safety of performing less radical surgery consisting of pelvic lymphadenectomy with cone biopsy, simple trachelectomy or simple hysterectomy in women with stage IA1 to IB1 cervical carcinoma. In addition, a prospective, multi-center, international trial is currently being performed to evaluate the outcomes of performing pelvic lymphadenectomy with conservative surgery (simple hysterectomy or cervical conization) in patients with favorable pathologic characteristics. Neoadjuvant chemotherapy followed by conservative surgery is also being explored as an option for patients with larger tumors and other pathologic characteristics that do not meet the criteria to perform conservative surgery alone.

CONCLUSIONS: The rate of parametrial involvement in women with early stage cervical cancer with favorable pathologic characteristics is low. Should the results of ongoing studies be favorable, conservative surgery could become the standard of care for certain women with early stage cervical cancer.