Surgical management of early cervical cancer: the shape of future studies

Early cervical cancer, in particular in the presence of favorable pathologic risk factors, accounts for a very low incidence of parametrial involvement and lymph node metastasis. This means that a less radical surgery may be an oncologically safe treatment in selected cases, with the aim of preserving fertility and/or reducing morbidity without compromising survival. The extensiveness of surgery has decreased relatively in recent decades, the "modified" radical hysterectomy still being the current gold standard by most international guidelines. Vaginal (or abdominal) radical trachelectomy, simple hysterectomy, or cervical conization has been proposed in association with pelvic lymphadenectomy. Sentinel lymph node mapping may be an option to avoid a complete pelvic lymphadenectomy. Ongoing research efforts are especially being made in properly identifying the patient subset suitable for a conservative/less radical approach and prospectively confirming the oncological safety of the proposed clinical-pathological algorithms.