[Operative standard therapy of micro- and macro-invasive carcinoma of the cervix]

Radical hysterectomy with bilateral lymphonodectomy represents one of the most important strategies in the treatment of cervical cancer, especially in early stage disease with small tumor volume. Nowadays, 5-year survival rates of patients with stage IB and IIA range between 87% and 92%. Ovary preserving management in cervical cancer is justified in early stage disease and younger women (< 45 years), and regarded as standard treatment. Therapy of microinvasive cervical cancer (Stage Ia1 und Ia2) depends on depth of invasion, superficial spread of lesion, and other prognostic criteria. Exact work-up of the cone is the basis for successful treatment. A great variety exists in regard to radicality of surgery in patients with cervical cancer--ranging between modified radical hysterectomy and radical hysterectomy with resection of the parametria to both pelvic side walls. Assessment of lymph node status is mandatory for individual treatment. Pelvic lymphonodectomy represents standard treatment at radical hysterectomy, and if positive, paraaortic lymphonodectomy is indicated. Micturition disorders, urinary incontinence, lymph cysts, bowel problems, thrombophlebitis, urogenital fistulas, and pulmonary embolism are the most frequent complications following radical hysterectomy. Today, there is an increasing competition between different therapy strategies in cervical cancer such as primary irradiation, chemoradiation, neoadjuvant chemotherapy, laparoscopic radical hysterectomy, vaginal radical hysterectomy combined with laparoscopic surgical staging. All these treatment modalities have to be compared with the "golden standard" comprising survival and recurrence rates functional results, morbidity, mortality and quality of life.