Conservative management of XXXX : is there a role for less radical surgery?

@entity1 @entity9216 @entity66 @entity5 @entity2622 @entity3846
OBJECTIVES: The utility of parametrial resection in @entity1 with @entity5 is controversial. In @entity1 with favorable pathologic characteristics such as @entity5 size <2cm and the absence of lymphovascular space invasion, the rate of parametrial involvement is very low. More conservative surgical approaches have therefore been suggested. The objective of this report is to review the existing literature in this area and to describe an ongoing prospective study evaluating the safety and efficacy of conservative surgery in @entity1 with @entity5 . METHODS: We performed a search of PubMed for English language articles published between 1970 and 2010 using the MeSH terms " @entity5 ", "conservative surgery", and "cone biopsy". RESULTS: Several retrospective studies have shown that <1% of @entity1 with @entity5 with favorable pathologic characteristics have parametrial involvement. In addition, approximately 60% of @entity1 undergoing radical trachelectomy have no @entity66 in the final pathologic specimen. Recent studies have reported on the feasibility and safety of performing less radical surgery consisting of pelvic lymphadenectomy with cone biopsy, simple trachelectomy or simple hysterectomy in @entity1 with stage @entity9216 to @entity3846 @entity2622 . In addition, a prospective, multi-center, international trial is currently being performed to evaluate the outcomes of performing pelvic lymphadenectomy with conservative surgery (simple hysterectomy or cervical conization) in @entity1 with favorable pathologic characteristics. Neoadjuvant chemotherapy followed by conservative surgery is also being explored as an option for @entity1 with @entity5 and other pathologic characteristics that do not meet the criteria to perform conservative surgery alone. CONCLUSIONS: The rate of parametrial involvement in @entity1 with @entity5 with favorable pathologic characteristics is low. Should the results of ongoing studies be favorable, conservative surgery could become the standard of care for certain @entity1 with @entity5 .
