Is parametrectomy always necessary with hysterectomy for cervical Ca?

The jury is still out, according to the findings of a recent study involving 594 women who underwent radical hysterectomy for invasive cervical cancer. The authors of the study concluded that for low-risk women with tumors less than 2 cm in diameter with negative pelvic lymph nodes and no lymphovascular space invasion, the risk of parametrial involvement is minimal, but whether parametrectomy can safely be omitted for these women remains a matter for further study.

Almost 11% of the women in the study developed parametrial metastases, which is a strong predictor of recurrence and decreased disease-free and overall survival. While radical hysterectomy has been linked with excellent local tumor control, the procedure can cause significant complications, largely because removing the parametrial tissue may affect nearby autonomic fibers that play a critical role in bladder, bowel, and sexual function. Preserving these fibers without increasing a woman's risk for cancer recurrence or death would greatly improve quality of life following hysterectomy.

Wright JD, Grigsby PW, Brooks R, et al. Utility of parametrectomy for early stage cervical cancer treated with radical hysterectomy. Cancer. 2007;110:1281-1286.