Conservative surgical management of small-volume stage IB1 cervical cancer

Objective To determine outcomes of women with small-volume stage IB1 disease managed by conservative surgical treatment. Design A retrospective review. SettingThe Northern Gynaecological Oncology Center, Queen Elizabeth Hospital, Gateshead, UK. Population Women with stage IB1 cervical cancer who were managed by conservative surgery over a 6-year period between 1 January 2000 and 31 December 2005. Main outcome measures Pelvic lymph node metastases, recurrence rates and outcome survival. Results A total of 17 women with conservatively managed stage IB1 cervical cancer were identified. Their ages were 25-67 years, median 37 years, 4 women were nulliparous. All women presented with an abnormal screening smear showing at least severe dyskaryosis. Estimated tumour volumes ranged from 16 to 640 mm(3), median 72 mm(3). Four women showed multifocal invasion. All four nulliparous women and one parous woman underwent fertility-sparing treatment, i.e. loop cone +/- laparoscopic pelvic node dissection. The other 12 women underwent laparoscopic assisted vaginal hysterectomy/total abdominal hysterectomy +/- pelvic lymph node dissection. There were no cases of residual disease in any of the definitive treatment specimens. There were no cases of metastatic spread to pelvic lymph nodes. To date, no women have developed recurrent disease, and all women are alive and well (median follow up, 29 months). Conclusions The conservative surgical management of small-volume stage IB1 cases in this series showed an excellent outcome with no cases showing pelvic lymph node involvement and no cases developing recurrent disease. A more formal assessment of tumour volume with a more active approach to determining the third dimension will allow more women the option of conservative treatment, thereby minimising the adverse effects of radical surgery.