How would you treat a woman who has had a simple, extrafascial hysterectomy for a clinically occult, pathologically FIGO stage IB1 cervical cancer?

Standard would be to do some form of radical hysterectomy and if not done add adjuvant RT.

That being said, the absolute risk of parametrial involvement for that size of disease is very low, and the benefit of RT if at all, is very small and requires a discussion of the pros and cons of intervention...

Agree with Dr. @Dr. First Last.

Only additional thought, 4 mm cervical stromal invasion out of how many mm total thickness? Some cervical stromas are 5-6 mm thick, others are 15 mm thick.

If the patient had a small cervix and therefore a deep 1/3 stromal invasion, then she'd meet Sedlis criteria and I...