IDENTIFICATION OF A LOW-RISK SUBSET OF PATIENTS WITH STAGE IB INVASIVE SQUAMOUS CANCER OF THE CERVIX POSSIBLY SUITED TO LESS RADICAL SURGICAL-TREATMENT

Because of the well-documented morbidity of radical hysterectomy, it w ould appear desirable to isolate a subset of patients at low risk of p arametrial spread or disease recurrence who might thereby be candidate s for less radical surgical therapy, To this end, the records of all p atients undergoing radical hysterectomy for cervical carcinoma at our institution between 1956 and 1985 were reviewed. Of the 387 patients t reated for squamous carcinoma clinically confined to the cervix, 83 (2 1.4%) had tumors with depth of invasion greater than 3 mm (stage IB) b ut volume of tumor less than or equal to that of a sphere 2 cm in diam eter (4.19 cm(3)) and no tumor in angiolymphatic spaces, Of the 83 pat ients, none had parametrial nodal metastasis, Median follow-up of this subgroup was 9.8 years, and the Kaplan-Meier estimate of 5-year disea se-free survival was 97.6% (95% confidence interval, 94.3-100%). We co nsider patients in the subset described above to be candidates for mod ified radical hysterectomy and pelvic lymphadenectomy, with a decrease in morbidity associated with the less radical dissection, a low risk of failure to excise occult parametrial tumor, and the expectation of an excellent chance of long-term disease-free survival. (C) 1995 Acadc mic Press, Inc.