Parametrial involvement and therapeutic programming in stage Ib cervical cancer.

The philosophical basis of oncological surgery has always been the removal of not only the primary lesion but also of a considerable amount of healthy tissue. In the surgical treatment of cervical cancer, the extensive dissection of the ureter, bladder and rectum facilitates a more complete removal of the parametrium and of the paracervical tissue, but gives rise to a series of bladder and rectal dysfunctions. Complications are certainly taken into account, but more consideration could be given to the cost to the patient in terms of severe disturbances in life-style and to the dysfunctions caused by radical surgery. Unfortunately, we do not know exactly the incidence of this damage since the data available from the literature are not always uniform. In order to overcome this discrepancy we suggest that Rutledge's classification is still the most valid point of reference. We also consider that accurate urodynamic follow-up methodology is necessary to evaluate bladder dysfunctions and to compare data from the different centres. Finally, we propose moderately radical hysterectomy--Rutledge's Class II--with adjuvant therapy in the presence of adverse prognostic factors as the most effective method for controlling the disease and reducing treatment-related side-effects.