Low-volume nodal disease in early-stage cervical cancer: a case report of favorable outcome without adjuvant therapy

Background: Low-volume nodal disease is increasingly detected in early-stage cervical cancer due to sentinel lymph node biopsy and ultrastaging. Although any nodal metastasis is classified as FIGO 2018 stage IIIC and generally warrants adjuvant chemoradiotherapy after radical surgery, the prognostic and therapeutic relevance of isolated micrometastases remains uncertain. Case presentation: A 58-year-old woman with FIGO 2018 stage IB2 HPV-related squamous cervical carcinoma underwent radical hysterectomy with bilateral adnexectomy and extended pelvic lymphadenectomy. Histopathological ultrastaging identified a single intracapsular micrometastasis in one of 41 pelvic lymph nodes examined (pT1b1 G2 pN1, FIGO IIIC1). Surgical margins and parametria were negative. Adjuvant concurrent chemoradiotherapy was formally indicated; however, severe postoperative wound infection with prolonged delayed healing prevented timely treatment. Given the extended recovery, absence of macrometastatic disease, and isolated micrometastasis without additional high-risk features beyond lymphovascular space invasion, close surveillance was adopted. At nearly 24 months of follow-up, the patient remains clinically, radiologically, and metabolically disease-free. Conclusion: This case underscores the need for continued investigation into the biological and clinical significance of minimal nodal tumor burden in early-stage cervical cancer. Further prospective data may help refine risk stratification and optimize treatment allocation within established guideline frameworks.