Microinvasive Cervical Adenocarcinoma (FIGO Stage 1A Tumors)
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Although studies suggest that microinvasive cervical adenocarcinoma has an excellent prognosis, none has reported treatment-related complications and many have lacked detailed measurement criteria. Our study looks at the rate of lymph node metastases and outcome, including complications, in patients with FIGO 1A1 and 1A2 adenocarcinomas of the cervix. Invasion was strictly defined, and the method of measurement was standardized. Villoglandular, papillary serous and clear cell carcinomas were excluded, as were tumors in which invasion exceeded 7 mm in width or 5 mm in thickness, with tumor thickness measured from the basement membrane of the overlying endocervical or ectocervical surface to the deepest focus of invasive tumor. A mean follow-up of 54 months (range, 5-159 months) was available for 31 of 32 (97%) patients. A total of 29 of 32 patients underwent hysterectomies, 2 patients had radical trachelectomies, and 1 patient was treated by cone biopsy. One patient received adjuvant radiotherapy. A total of 27 of 32 patients had bilateral pelvic lymph node dissections, and no lymph node metastases were identified. No recurrences have been reported to date. One patient died of metastatic ovarian carcinoma 82 months after her diagnosis of cervical carcinoma. Two of 27 (7%) patients have chronic leg edema secondary to lymph node dissection. Given the excellent prognosis of this tumor, the absence of lymph node metastases and a lymph node dissection complication rate of 7%, less radical surgery should be considered in this low-risk patient population.
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