Surgery for early stage cervical cancer: how radical should it be?

Gynecol Oncol. 2013 Oct;131(1):222-30. doi: 10.1016/j.ygyno.2013.07.078. Epub 2013 Jul 14.


Objective: Less radical or non radical surgery for early-stage cervical cancer has been proposed to reduce morbidity while maintaining oncologic outcomes. Given that a standardized approach to conservative surgery is not yet available, we have summarized the literature on less radical surgery to better inform clinical practice.

Methods: MEDLINE R and MEDLINE in-process and non-indexed citations were searched from inception to April 14, 2013 to identify all English-language articles evaluating less-radical or non radical surgery for invasive cervical carcinoma. Articles including patients with squamous cell carcinoma, adenocarcinoma and adenosquamous carcinoma were included and a narrative review of the literature is presented.

Results: Radical surgery is associated with significant adverse effects in terms of urinary function, sexual function, and body image. Radical trachelectomy is an accepted fertility-sparing option, but still leads to morbidity from parametrectomy. The importance of the parametrectomy in patients with small early-stage tumors has been questioned recently, and many studies have found simple hysterectomy and simple trachelectomy can be safe in appropriately selected patients. Cone biopsy may be a fertility-sparing option in those patients with a very low risk of parametrial involvement. Neoadjuvant chemotherapy is also being investigated as a method to reduce the need for radical surgery. Sentinel lymph node biopsy is discussed as a method to reduce the morbidity while increasing the sensitivity of pelvic lymph node assessment in women with early cervical cancers. Finally, the treatment of early adenocarcinoma is addressed.

Conclusions: It appears many women with early-stage cervical cancer can be treated less radically than has been done in the past. Large prospective trials are underway to further define candidates for less-radical surgery.

Keywords: Cervical cancer; Cone biopsy; Less radical surgery; Radical hysterectomy; Simple hysterectomy; Trachelectomy.

Publication types

  • Review

MeSH terms

  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery
  • Carcinoma / drug therapy
  • Carcinoma / pathology*
  • Carcinoma / surgery*
  • Chemotherapy, Adjuvant
  • Female
  • Fertility Preservation
  • Humans
  • Hysterectomy
  • Neoadjuvant Therapy
  • Neoplasm Staging
  • Sentinel Lymph Node Biopsy
  • Uterine Cervical Neoplasms / drug therapy
  • Uterine Cervical Neoplasms / pathology*
  • Uterine Cervical Neoplasms / surgery*