Uterus-conserving surgery for invasive cervical cancer

Abstract

Standard treatment for cervical cancer is either radical hysterectomy or radiotherapy to the pelvis. Either will inevitably compromise fertility, rendering future childbearing impossible. Precise staging and magnetic resonance imaging can indicate the site and location of the tumour. Radical wide local excision of early-stage small tumours can allow conservation of the uterine corpus and the potential for fertility preservation. An isthmic vaginal anastomosis restores continuity of the vaginal canal after insertion of an isthmic cerclage. This will keep the isthmus competent but still allow menstruation. Pelvic lymphadenectomy is performed laparoscopically. This new approach combines current developing minimal access techniques with laparoscopic pelvic sidewall dissection and lymphadenectomy. The bottom or inferior part of a traditional radical vaginal hysterectomy is performed simultaneously. Over 400 cases have been reported with 100 live births. Premature rupture of the membranes is a risk. Delivery is by classical Caesarean section. Fertility rates are good and recurrence rates are low at 4%. This technique appears to be safe in well-selected cases and when performed in centres with suitable experience of radical vaginal surgery and laparoscopic techniques. Obstetric management in high-risk feto-maternal units is necessary in view of the risk of prematurity.