EXTENDED RADICAL HYSTERECTOMY IN EARLY-STAGE CARCINOMA OF THE UTERINECERVIX - TAILORING THE RADICALITY

The question of whether surgical treatment in early-stage cervical can cer should be aggressive or restricted to less radical techniques is s till controversial. To answer this question it was thought useful to i nvestigate the correlation of parametrial lymph node metastases with e xtension and stage of disease. Two-hundred and sixty-three consecutive primary radical surgical procedures were performed in our institute i n clinical stage IB or stage IIA cervical cancer. Positive parametrial nodes were found in 6.9% of cases: 5% in stage IB (3% in the proximal part of the parametrium and 2% in the distal part, near the pelvic wa ll) and 16.3% in stage IIA (7% proximal and 9.3% distal) (P = 0.0193). During a median follow-up period of 92 months, disease recurred in 17 .1% and 17.6% of cases, in negative and positive parametria, respectiv ely. The 5-year overall and disease-free survival rates were 80.4% and 81.6% for patients with negative and positive parametria, respectivel y. From this experience it is concluded that the extent of radical hys terectomy should be related to the extent of the disease on the basis of modern knowledge of the pattern of spread. The principal key to pro gnosis remains pelvic and paracavoaortic nodal status.