Conservative surgery for early stage cervical carcinoma

Abstract

Advanced cervical cancer continues to present a major health care challenge in the developing world. In contrast, in our own culture, the incidence of the disease is falling. However, the condition is presenting at an earlier stage and to younger patients who may wish to preserve their fertility, if possible. The traditional treatment, of radical surgery with adjuvant chemo-radiotherapy or primary chemo-radiotherapy, conflicts with such wishes. Therefore, techniques have been developed in the last 10 years, which aim to preserve fertility without compromising clinical outcome.

The newer techniques, which have been evaluated range from cone biopsy with or without lymphadenectomy through to radical trachelectomy. The latter technique is accumulating evidence of satisfactory oncological outcome, acceptable complication data and successful maternity outcome. However, the obstetric course for these patients is not guaranteed or straightforward. Most recently, treatments incorporating pre-operative chemotherapy followed by cone biopsy with lymphadenectomy have been described. Such a policy is likely to produce more obstetric gains but it must not be at the expense of oncological outcome, unless requested by the patient.

The need for consistent high-quality imaging, histopathology and clinical decision-making supports the concept that such care should only be developed and available in highly specialized centres. The requirement for comprehensive data collection and follow up of oncological variables, obstetric outcome and complication rates should be mandatory. New more conservative methods should only be developed under strict scientific control, using the traditional methods as comparators. However, it is possible that such fertility preserving techniques may be very attractive to some patients, even if they are increasing their risk of recurrent cervical cancer.