Parametrial resection in cervical cancer: optimizing oncological outcomes and complications

Aims: To evaluate the impact of the extent of parametrial resection on oncological outcomes and postoperative complications in early-stage cervical cancer patients undergoing type III radical hysterectomy.Methods: A retrospective analysis was conducted on 38 patients treated between 2011 and 2022 with type III radical hysterectomy and pelvic/paraaortic lymphadenectomy. Parametrial length and volume were measured, and postoperative complications were assessed using Clavien-Dindo Grade III and IV criteria. Associations between parametrial resection extent, complications, blood transfusion, recurrence, and mortality were analyzed using univariate and multivariate logistic regression, adjusting for tumor stage.Results: Median follow-up was 32.0 months. Major complications occurred in 11 patients (28.9%): ureteral injury (n=6), bladder dysfunction (n=2), fascial dehiscence (n=2), and pelvic abscess (n=1). Greater parametrial length significantly correlated with these complications (p=0.007) and transfusion needs (p=0.023). Recurrence (26.3%) and mortality (21.1%) were independent of resection extent. Each 1 cm increase in parametrial length increased the odds of major complications (OR=2.953, 95% CI 1.245-7.004) and transfusion (OR=2.117 95% CI 1.072-4.181). Conclusion: These findings suggest that limiting the lateral extent of parametrial resection may reduce morbidity. Although our limited, retrospective cohort did not show a significant negative impact on recurrence or mortality, the statistical power is insufficient to definitively confirm oncological safety. This supports a risk-adapted approach, underscoring the need for larger prospective studies.