Rethinking surgical concepts for early cervical cancer

Radical hysterectomy and pelvic with/without para-aortic lymphadenectomy have been widely accepted as the preferred surgical treatments in patients with early-stage cervical cancers, including those with International Federation of Gynecology and Obstetrics (FIGO) stages IB–IIA. During this procedure, gynecologic oncologists aim to remove malignant lesions in the cervix, with a radial safety margin of 1–2 cm in the vagina and mesometrium. In cases of early cervical cancer where resection margins are very close to the bladder and rectum, most surgeons do not perform resections because of the lack of adequate safety margins. Furthermore, surgeons sometimes confront microscopic parametrial involvement in the final pathology report after radical surgery. Even in cases with histologically confirmed clear resection margins, adjuvant radiation therapy has usually been administered to improve locoregional control of microscopic parametrial involvement. Unfortunately, this bimodal therapy strategy increases treatment-related morbidity and has uncertain effects on overall survival.