Who should be offered non-radical surgery for early-stage cervical cancer?

Abstract

Cervical cancer is the fourth most common cancer in women worldwide [1]. The standard treatment for early-stage cervical cancer such as the International Federation of Gynecology and Obstetrics (FIGO) stage IB is radical hysterectomy combined with bilateral pelvic lymph node assessment [2]. Radical trachelectomy is a safe alternative for young women who wish to preserve fertility [3]. The 5-year survival rate is excellent, ranging from 73.4% to 97.5% [4-6]. However, those radical procedures have significant morbidity, mainly as a result of the removal of the parametria. The parametrectomy is the most challenging part of the procedure and major complications have been reported such as blood loss, bladder and rectal dysfunction, sexual dysfunction, and fistula formation [7-12]. In recent years, the value of radical hysterectomy or trachelectomy in early-stage cervical cancer has been questioned. Parametrial involvement in early-stage cervical cancer with favorable prognostic factors can be as low as 1% [13-15]. Several reports have suggested that less radical surgery such as cervical conization, simple trachelectomy or simple hysterectomy with pelvic lymph node assessment is probably sufficient in well-selected early-stage cervical cancer to achieve excellent oncologic outcomes [16-19]. Reade et al. [13] recently summarized those reports and identified 476 women with early-stage cervical cancer managed with non-radical surgery. The reported recurrence rate was 1.5% and the rate of cancer-related death was 0.5%. Although level I evidence is still missing, this report suggests that non-radical surgery is probably a safe option in low-risk early-stage cervical cancer patients.