Advances in the surgical management of invasive cervical cancer

Cervical cancer is the second most frequent cancer in women in the world. Surgery plays a major role, particularly in patients with early-stage disease. This review focuses on the evaluation of important papers published since January 2003 on the management of invasive cervical cancer.

Patients are classified as having early-stage (stage IB1) or advanced-stage (stage IB2 or greater) disease. Several papers are devoted to the evaluation of prognostic factors in patients with early-stage disease and negative nodes. Several recurrences after radical trachelectomy have been reported that remind us that strict selection criteria are mandatory for conservative management. The development of sentinel node and laparoscopic procedures has gained momentum. For patients with advanced-stage disease, the place of staging procedures in para-aortic areas or pelvic surgery after chemoradiation therapy continues to be debated and is currently being investigated in randomized studies. Several papers also continue to debate surgical treatment modalities for recurrent disease (the place of laparoscopy and reconstructive surgery).

Several interesting papers have been published since 2003 about the surgical treatment of cervical cancer. Laparoscopic surgery and the sentinel node procedure have developed considerably, particularly for the surgical management of early-stage disease. The results of ongoing studies are awaited to determine the value of pelvic surgery (after neoadjuvant treatment) in patients with advanced-stage disease.