Surgical Outcomes of Patients with Stage IA2 Cervical Cancer Treated with Radical Hysterectomy

  • Mahawerawat, Sukanda (Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University) ;
  • Charoenkwan, Kittipat (Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University) ;
  • Srisomboon, Jatupol (Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University) ;
  • Khunamornpong, Surapan (Department of Pathology, Faculty of Medicine, Chiang Mai University) ;
  • Suprasert, Prapaporn (Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University) ;
  • Sae-Teng, Charuwan Tantipalakorn (Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University)
  • Published : 2013.09.30


Background: This study was undertaken to evaluate the surgical outcomes of patients with stage IA2 cervical cancer treated with radical hysterectomy. Data for 58 patients who underwent modified radical hysterectomy or radical hysterectomy with pelvic lymphadenectomy between January 2003 and December 2012 at Chiang Mai University Hospital were retrospectively reviewed. The analysis included clinico-pathological risk factors (nodal metastasis, parametrial involvement), adjuvant treatment, 5-year disease-free survival and 5-year overall survival. All pathologic slides were reviewed by a gynecologic pathologist. Follow-up methods included at least cervical cytology and colposcopy with directed biopsy if indicated. Univariate analysis was performed to identify factors associated with median survival. At the median follow up time of 73 months, the 5-year disease-free survival and the 5-year overall survival were 97.4% and 97.4%, respectively. Two (3.4%) patients had pelvic lymph node metastases. In a univariate analysis, there was no statistically significant association between survival and prognostic factors such as age, histological cell type, lymph-vascular space invasion, vaginal margin status and lymph node status. Surgical and survival outcomes of women with stage IA2 cervical cancer are excellent. No parametrial involvement was detected in our study. Patients with stage IA2 cervical cancer may be treated with simple or less radical hysterectomy with pelvic lymphadenectomy.


Cervical cancer;stage IA2;microinvasive cervical cancer


  1. Burghardt E, Girardi F, Lahousen M, et al (1991). Microinvasive carcinoma of the uterine cervix (International Federation of Gynecology and Obstetrics Stage IA). Cancer, 67, 1037-45.<1037::AID-CNCR2820670429>3.0.CO;2-2
  2. Benedet JL, Anderson GH (1996). Stage IA carcinoma of the cervix revisited. Obstet Gynecol, 87, 1052-9.
  3. Covens A, Rosen B, Murphy J, et al (2002). How important is removal of the parametrium at surgery for carcinoma of the cervix? Gynecol Oncol, 84, 145-9.
  4. Creasman WT (1999). Stage IA cancer of the cervix: finally some resolution of definition and treatment? Gynecol Oncol, 74, 163-4.
  5. Ditto A, Martinelli F, Mattana F, et al (2011). Class III nervesparing radical hysterectomy versus standard class III radical hysterectomy: an observational study. Ann Surg Oncol, 18, 3469-78.
  6. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917.
  7. Hosaka M, Watari H, Mitamura T, et al (2011). Survival and prognosticators of node-positive cervical cancer patients treated with radical hysterectomy and systematic lymphadenectomy. Int J Clin Oncol, 16, 33-8.
  8. Kolstad P (1989). Follow-up study of 232 patients with stage Ia1 and 411 patients with stage Ia2 squamous cell carcinoma of the cervix (microinvasive carcinoma). Gynecol Oncol, 33, 265-72.
  9. Mejia-Gomez J, Feigenberg T, rbel-Alon S, et al(2012). Radical trachelectomy: a fertility- sparing option for early invasive cervical cancer. Isr Med Assoc J, 14, 324-8.
  10. Landoni F, Maneo A, Zapardiel I, et al (2012). Class I versus class III radical hysterectomy in stage IB1-IIA cervical cancer. A prospective randomized study. Eur J Surg Oncol, 38, 203-9.
  11. Landoni F, Zanagnolo V, Lovato-Diaz L, et al(2007). Ovarian metastases in early-stage cervical cancer (IA2-IIA): a multicenter retrospective study of 1965 patients (a Cooperative Task Force study). Int J Gynecol Cancer, 17, 623-8.
  12. Mabuchi S, Okazawa M, Kinose Y, et al (2012). Comparison of the prognoses of FIGO stage I to stage II adenosquamous carcinoma and adenocarcinoma of the uterine cervix treated with radical hysterectomy. Int J Gynecol Cancer, 22, 1389-97.
  13. Pecorelli S, Zigliani L, Odicino F (2009). Revised FIGO staging for carcinoma of the cervix. Int J Gynaecol Obstet, 105, 107-8.
  14. Pluta M, Rob L, Charvat M, et al (2009). Less radical surgery than radical hysterectomy in early stage cervical cancer: a pilot study. Gynecol Oncol, 113, 181-4.
  15. Quinn MA, Benedet JL, Odicino F, et al (2006). Carcinoma of the cervix uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet, 95, 43-103.
  16. Rogers LJ, Luesley DM (2009). Stage IA2 cervical carcinoma: how much treatment is enough? Int J Gynecol Cancer, 19, 1620-4.
  17. Sakuragi N (2007). Up-to-date management of lymph node metastasis and the role of tailored lymphadenectomy in cervical cancer. Int J Clin Oncol, 12, 165-75.
  18. Spoozak L, Lewin SN, Burke WM, et al (2012). Microinvasive adenocarcinoma of the cervix. Am J Obstet Gynecol, 206, 80-6.
  19. Webb JC, Key CR, Qualls CR, et al (2001). Population-based study of microinvasive adenocarcinoma of the uterine cervix. Obstet Gynecol, 97, 701-6.
  20. Tabata M, Ichinoe K, Sakuragi N, et al (1987). Incidence of ovarian metastasis in patients with cancer of the uterine cervix. Gynecol Oncol, 28, 255-61.
  21. Toki N, Tsukamoto N, Kaku T, et al (1991). Microscopic ovarian metastasis of the uterine cervical cancer. Gynecol Oncol, 41, 46-51.
  22. Verleye L, Vergote I, Reed N, et al (2009). Quality assurance for radical hysterectomy for cervical cancer: the view of the European Organization for Research and Treatment of Cancer-Gynecological Cancer Group (EORTC-GCG). Ann Oncol, 20, 1631-8.

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