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Conservative surgery for microinvasive carcinoma of the cervix
1Department of Obstetrics and Gynecology, University of Graz, Austria.
Objective:
To evaluate the prognosis of patients with stage IA1 and IA2 microcarcinoma of the cervix according to the 1994 FIGO classification.
Methods:
The histologic specimens of 494 patients who underwent conization for microcarcinoma of the cervix between 1958 and 1992 were reviewed and classified according to the 1994 FIGO system.
Results:
After a mean follow-up of 14 years (range, 1-35) 2 patients with stage IA1 tumors and 2 patients with stage IA2 tumors died of disease. Patients with early stromal invasion only accounted for 70% of patients with stage IA1 lesions. If these patients are excluded from stage IAI, the mortality rates for stage IA1 and IA2 did not differ significantly. Surgical radicality declined markedly during the study period.
Conclusion:
Neither the 1985 nor the 1994 FIGO classification of microcarcinoma can be used as a guide to therapy. Conization only suffices for patients with early stromal invasion or a depth of invasion of 1-3 mm without lymph vascular space involvement. Additional pelvic lymphadenectomy can be considered for patients with stage IA1 lesions with lymph vascular space involvement. Removal of the tumor and pelvic lymphadenectomy is indicated for all patients with stage IA2 lesions, regardless of lymph vascular space involvement. Radical vaginal or radical abdominal hysterectomy represent overtreatment for patients with microcarcinomas because parametrial involvement in these patients has not been demonstrated.
