The incidence of parametrial tumor involvement in select patients with early cervix cancer is too low to justify parametrectomy

Stegeman, M.; Louwen, M.; Velden, J. van der; Kate, F. J. W. Ten; Bakker, Marleen; Burger, Curt W.; Ansink, Anca C.

doi:10.1016/j.ygyno.2007.01.016

Cited by 138 publications

(98 citation statements)

References 28 publications

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“…Hence, a more conservative approach may be considered in those women [6,19,20]. Pluta et al, evaluated 60 patients with FIGO stage IA1 and IB1 cervical cancer who had < 2cm tumor size and < 50% cervical stromal invasion.…”

Section: Discussionmentioning

confidence: 99%

“…Direct extension and lymphatic dissemination are the most common routes of spread in cervical cancer. There-fore, parametrium and lymph nodes are typical metastasis locations and removal of these tissues is vial in cervical cancer treatment [6]. However, most of the complications related to radical hysterectomy are also associated with parametrial resection due to autonomic nerve damage [7].…”

Section: Introductionmentioning

confidence: 99%

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Clinical and pathological characteristics related to parametrial involvement in clinical early-stage cervical cancer

Boyraz

Başaran²,

Salman³

et al. 2016

Ginekol Pol

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Objectives: Since parametrial involvement is believed to be a crucial factor in the management of cervical cancer, our study was designed to investigate the clinical and pathological features which predicted parametrial involvement in patients with clinical early-stage cervical cancer. Material and methods:The study included patients with clinical early-stage cervical cancer who underwent radical hysterectomy with pelvic and para-aortic lymphadenectomy between December 2001 and August 2014, at the Hacettepe University Hospital. The clinical and pathological characteristics of the affected patients were evaluated, including age, histologic subtype, tumor size, depth of cervical stromal invasion, lympho-vascular space invasion (LVSI), and lymph node metastasis. Univariate and multivariate analyses were performed to reveal factors associated with parametrial involvement. Results:The study group consisted of 126 patients (mean age: 52.7 years; range: 29-83), including 101 (80.2%) with squamous, 19 (15.1%) with adenocarcinoma, and 6 (4.8%) with adenosquamous histological subtype of cervical cancer. Parametrial involvement and lymph node metastasis were detected in 41 (32.5%) and 46 (36.5%) women, respectively. Univariate analysis showed that deep cervical stromal invasion, LVSI, tumor size > 2 cm and lymph node metastasis were associated with parametrial involvement. Multivariate logistic regression analysis identified the independent risk factors associated with parametrial involvement as LVSI (OR 8.93, 95% CI 1.1-73.5, p = 0.042) and lymph node metastasis (OR 8.8, 95% CI 1.5-9.3, p = 0.004).Conclusions: LVSI, deep cervical stromal invasion, lymph node metastasis and tumor size are significantly associated with parametrial involvement in patients with clinical early-stage cervical cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical and pathological characteristics related to parametrial involvement in clinical early-stage cervical cancer

Boyraz

Başaran²,

Salman³

et al. 2016

Ginekol Pol

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“…Se encontró que el estado ganglionar linfático pélvico es el predictor independiente más fuerte para presentar CP, conjuntamente con la profundidad de infiltración. Este factor ha sido previamente reportado como un predictor sólido de propagación parametrial (7,18,(21)(22)(23)(24)(25)(26)(27)(28) .…”

Section: Discussionunclassified

“…La mayoría de los estudios coinciden en que el tamaño tumoral < 2 cm es un criterio de bajo riesgo. Algunos estudios coinciden en otros criterios de bajo riesgo que alcanzan significancia estadística, como la ausencia de permeación linfovascular, la ausencia de compromiso de ganglios linfáticos de la pelvis, o la profundidad de la invasión menor a 10 mm (7,18,(21)(22)(23) . de pacientes incluidos en nuestra serie (214 casos) identifica 97 pacientes con estos criterios (asociados a bajo riesgo de CP en la bibliografía).…”

Section: Discussionunclassified

Compromiso parametrial en pacientes con cáncer de Cérvix IB-1 tratadas con histerectomía radical en Perú

Urrutia

Santos

Zevallos

et al. 2014

Rev Peru Med Exp Salud Publica

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Objetivos. Evaluar la frecuencia y factores asociados al compromiso parametrial (CP) en pacientes con cáncer de cérvix IB-1 sometidas a histerectomía radical (HR) en el Instituto Nacional de Enfermedades Neoplásicas del Perú. Materiales y métodos. Estudio transversal analítico en 214 pacientes con cáncer de cérvix IB-1 sometidas a HR con linfadenectomía pélvica entre el 2007 y 2012. Se comparó la población con y sin CP según variables clinicopatológicas como edad, tamaño tumoral, profundidad de infiltración, grado histológico y afectación ganglionar pélvica. Resultados. Diez pacientes (4,6%) presentaron CP. El análisis multivariable mostró que la profundidad de la invasión (OR 8,37, IC 95%: 1,41, p=0,029) y el compromiso de ganglios pélvicos (OR 18,03, IC 95%: 3,44, p=0,001) resultaron ser predictores independientes del CP. La presencia de tamaño tumoral ≤ 2 cm, invasión ≤ 10 mm, ausencia de permeación linfovascular y ausencia de compromiso ganglionar permitió identificar 97 pacientes de bajo riesgo de CP, de los cuales ninguno tuvo CP en patología. Conclusiones. Confirmamos la baja frecuencia del CP en el subgrupo de cáncer de cervix IB-1 y su asociación con la profundidad de la invasión y con el compromiso ganglionar linfático sugeridos en estudios previos. Esta información permitirá identificar un subgrupo de pacientes con bajo riesgo de CP candidatas a una cirugía menos radical en nuestra institución. Palabras clave: Cáncer del cuello uterino; Histerectomía; Escisión del ganglio linfático (fuente: DeCS BIREME). PARAMETRIAL INVOLVEMENT IN CERVICAL CANCER IB1 PATIENTS TREATED WITH RADICAL HYSTERECTOMY IN PERU ABSTRACTObjectives. To assess the frequency and factors associated with parametrial involvement (PI) in patients with cervical cancer IB1 who underwent radical hysterectomy (RH) at the National Institute of Neoplastic Diseases in Peru. Materials and methods. Cross-sectional study of 214 patients with cervical cancer IB1 undergoing RH with pelvic lymphadenectomy between 2007 and 2012. The population was compared with and without clinicopathological variables associated with PI such as age, tumor size, depth of infiltration, histological grade and pelvic lymph node involvement. Results. Ten patients (4.6%) had PI. Multivariate analysis showed that the depth of invasion (OR 8.37, p=0.029) and pelvic node involvement (OR 18.03; p=0.001) were all independent predictors of PI. The presence of tumor size ≤ 2 cm, invasion ≤ 10 mm, absence of lymphovascular permeation and absence of nodal involvement identified 97 patients at low risk of PI, none of whom had PI pathology. Conclusions. We confirmed the low frequency of PI in the cervical cancer IB1 subgroup and its association with the depth of invasion and lymph node involvement suggested in previous studies. This information will allow the identification of a subgroup of patients at low risk of PI for less radical surgery in our institution.

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“…Although the anatomical concept of the parametrium has recently been discussed (4,5), parametrectomy remains an integral part of surgical treatment and defines the radicality of hysterectomy (1). Parametrium involvement (PI) is low in the early stages of cervical cancer (6)(7)(8) affecting only 8% of women with negative pelvic lymph nodes in early-stage (9)(10)(11). However, parametrectomy is the most difficult step of radical hysterectomy and the main source of complications: severe perioperative complications occurred in 10-15% of patients and late urologic and rectal dysfunctions related to nerve injury in 20-30% raising the issue of its legitimacy (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Clues pointing to simple hysterectomy to treat early-stage cervical cancer

Coutant

Cordier²,

Guillo³

et al. 2009

Oncol Rep

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Abstract. Radical hysterectomy and pelvic lymphadenectomy is recommended for stage Ia2-Ib1 cervical cancer while parametrial involvement (PI) is rare. Our aim was to evaluate criteria to select women with low risk of PI that could benefit from simple hysterectomy. Factors associated with low risk of PI were analyzed in a series of 37 patients with stage Ia2-Ib1 cervical cancer undergoing radical hysterectomy and sentinel lymph node procedure from 2003 to 2008. PI was associated with tumor size (p<0.001) and lymphovascular space invasion (LVSI) (p=0.007). PI was found in 4.5% of patients with tumor size ≤2 cm versus 33% with tumor size >2 cm (p=0.04). The negative predictive value was 100% for absence of LVSI (95% CI: 0.83-1) and for combinations: tumor size ≤2 cm and SN negative (95% CI: 1-1), tumor size ≤2 cm and no LVSI (95% CI: 0.86-1), tumor size ≤2 cm and tumor grade 1-2 and no LVSI (95% CI: 0.82-1), and tumor size ≤2 cm and PLN negative and no LVSI (95% CI: 0.83-1). Among various combinations, a tumor size ≤2 cm and absence of LVSI appears the most relevant to predict parametrial status.

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The incidence of parametrial tumor involvement in select patients with early cervix cancer is too low to justify parametrectomy

Cited by 138 publications

References 28 publications

Clinical and pathological characteristics related to parametrial involvement in clinical early-stage cervical cancer

Clinical and pathological characteristics related to parametrial involvement in clinical early-stage cervical cancer

Compromiso parametrial en pacientes con cáncer de Cérvix IB-1 tratadas con histerectomía radical en Perú

Clues pointing to simple hysterectomy to treat early-stage cervical cancer

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