Utility of parametrectomy for early stage cervical cancer treated with radical hysterectomy

Jason D. Wright, Perry W. Grigsby, Rebecca Brooks, Matthew A. Powell, Randall K. Gibb, Feng Gao, Janet S. Rader, David G. Mutch

Research output: Contribution to journalArticlepeer-review

151 Scopus citations

Abstract

BACKGROUND. Removal of the parametrial soft tissue is recommended for patients with cervical cancer undergoing radical hysterectomy. Parametrectomy results in significant morbidity. The objective of the study was to determine factors predictive of parametrial tumor spread and to define a subset of patients at low risk for parametrial disease. METHODS. Patients with invasive cervical cancer who underwent radical hysterectomy from 1989-2005 were examined. Analysis was performed to determine factors associated with parametrial tumor spread. Survival estimates were determined using the Kaplan-Meier method. RESULTS. A total of 594 patients were identified. Parametrial metastases were documented in 64 (10.8%). Factors associated with parametrial disease were: histology, advanced grade, deep cervical invasion, lymphovascular space invasion (LVSI), large tumor size, advanced stage, uterine or vaginal involvement, and pelvic or paraaortic lymph node metastases (P < .0001 for each). Parametrial metastases were associated with increased risk of recurrence and decreased disease-free and overall survivals (P < .0001). A subgroup analysis was performed to identify patients at low risk for parametrial spread. In pelvic node-negative women parametrial disease was noted in 6.0% (30/498) compared with 47.9% (34 of 71) of those with positive pelvic nodes (P < .0001). If further stratified to women with negative nodes, no LVSI, and tumors <2 cm, the incidence of parametrial disease was only 0.4%. CONCLUSIONS. Parametrial spread is a strong predictor of recurrence and decreased survival. Parametrial invasion is rare in patients with small tumors, no LVSI, and negative pelvic nodes (no poor prognostic factors). Further study is warranted to determine the feasibility of omitting parametrectomy in these low-risk patients.

Original languageEnglish (US)
Pages (from-to)1281-1286
Number of pages6
JournalCancer
Volume110
Issue number6
DOIs
StatePublished - Sep 15 2007
Externally publishedYes

Keywords

  • Cervical cancer
  • Parametrectomy
  • Parametrium
  • Radical hysterectomy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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