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. 2022 Feb 11;82(2):139–180. doi: 10.1055/a-1671-2158
No. Recommendations/Statements GoR LoE Sources
8.14.
modified 2021
Consensus-based recommendation
In stages IB1 and IIA1, treatment should be administered as follows:
Surgery:
  • If there are negative lymph nodes (pelvic) after surgical staging:

    • Radical hysterectomy with resection of the medial (near the uterus) half of the parametria, with an adequate safety margin and resection within healthy margins (Piver II).

    • With a tumor-free resection margin at the vaginal cuff (IIA1).

  • If the tumor is < 2 cm, with no risk factors:

    • Surgical staging with SNB and

    • Radical hysterectomy with resection of the medial (near the uterus) half of the parametria, with an adequate safety margin and resection within healthy margins (Piver II).

    • With a tumor-free resection margin at the vaginal cuff (IIA1).

  • If the patient is wishing to have children and the tumor is < 2 cm without risk factors:

    • Surgical staging with SNB and

    • Radical trachelectomy with prophylactic permanent cerclage.

  • If family planning has been completed:

    • Secondary hysterectomy.

  • If there are pelvic lymph-node metastases:

    • Additional para-aortic lymphadenectomy (surgical staging).

  • In postmenopausal patients:

    • Bilateral adnexectomy.

  • In premenopausal patients:

    • Ovariopexy to maintain intrinsic ovarian function.

  • If there are pelvic and/or para-aortic lymph nodes macroscopically affected by tumor:

    • Surgical removal of the nodes, or radio(chemo)therapy.

Radio(chemo)therapy:
  • When there is histological evidence of pelvic and/or para-aortic lymph-node metastases, or several confirmed risk factors:

    • R(CH)T.

  • If the patient is inoperable or requests it:

    • R(CH)T.

  • The radiation volume should be based on the anatomy and histologically confirmed lymph-node involvement.

EC