Received: 15 September 2016 Accepted: 20 March 2017 Published on: 21 April 2017
Surgical treatment and outcome of early invasive
adenocarcinoma of the uterine cervix (FIGO stage IA1)
Department of Obstetrics and Gynecology,
Graduate School of Medical Sciences, Kyushu
University, Fukuoka, Japan
Department of Health Sciences, Graduate
School of Medical Sciences, Kyushu University,
Kenzo Sonoda MD,Department of Obstetrics
and Gynecology, Graduate School of Medical
Sciences, Kyushu University, 3-1-1 Maidashi,
Higashi-ku, Fukuoka, 812-8582, Japan.
Japan Society for the Promotion of Science (no.
Aim: To investigate the surgical outcome of FIGO stage IA1 cervical adenocarcinoma.
Methods: Between 2005 and 2011, 12 patients from Kyushu University Hospital had cervical ade-
nocarcinoma, with a tumor depth of less than 3 mm and a horizontal width of less than 7 mm (FIGO
stage IA1), diagnosed by cervical conization. All patients underwent simple hysterectomy or sim-
ple trachelectomy with pelvic lymphadenectomy.
Results: The mean patient age was 34 years (range, 26–70 years). The median follow-up period
was 70.5 months (range, 26–99 months). No pelvic lymph-node metastasis was seen, and no
patient experienced disease recurrence.
Conclusion: Early invasive cervical adenocarcinoma with a depth of invasion of 3 mm or less and
a horizontal spread of 7 mm or less has little potential for nodal metastasis or recurrence. There-
fore, simple hysterectomy or trachelectomy, without lymphadenectomy, might be an alternative
treatment option for stage IA1 cervical adenocarcinoma.
cervical adenocarcinoma, FIGO stage IA1, simple hysterectomy, simple trachelectomy, surgical
The natural history of early cervical adenocarcinoma is not fully under-
stood, and proper disease management is controversial. In Japan, stage
IA cervical adenocarcinoma is deﬁned as microinvasive adenocarci-
noma conﬁned to the region of the normal endocervical glands; sub-
classiﬁcation was not incorporated in the Japanese general rules for
clinical and pathological management until March 2012. For this rea-
son, the Japanese deﬁnition differs from that speciﬁed by the Inter-
national Federation of Gynecology and Obstetrics (FIGO) in 2008, in
which states that stage IA refers to a lesion with a depth of invasion
depth of 5 mm or less.
Depth of invasion is among the criteria used to predict pelvic lymph-
node metastasis and disease recurrence.
In this study, we evaluated
the validity of our operative procedures and prognostic outcomes in
order to standardize surgical procedures for FIGO stage IA1 cervical
2 PATIENTS AND METHODS
A total of 120 patients with adenocarcinoma of the uterine cervix
were treated at the Department of Gynecology and Obstetrics of
Kyushu University Hospital between 2005 and 2011. Twelve of the
120 patients were treated for microinvasive adenocarcinoma, deﬁned
according to the FIGO classiﬁcation system as stage IA1; all med-
ical records were retrospectively reviewed for these 12 patients.
We obtained written informed consent for this retrospective review
from all patients and collected data on lymph-node metastasis, dis-
ease recurrence and complications. We re-evaluated the histopatho-
logical records for depth of invasion, horizontal tumor extension and
lymphovascular-space involvement. Follow-up data were available for
Simple hysterectomy was deﬁned as a removal of the uterus that
involved ligation and dissection of the uterine vessels and paracervi-
cal tissues at the near-cervix in the form of Rutledge type 1. Simple
2017 John Wiley & Sons Australia, Ltd Asia-Pac J Clin Oncol. 2018;14:e50–e53.wileyonlinelibrary.com/journal/ajco