Surgical approaches for advanced or recurrent cancer of the cervix

The American Cancer Society estimates that in 1987 13,000 women in the United States will develop invasive cervical cancer, and 6800 women will die of this disease. Two groups of patients contribute significantly to mortality from cervical cancer. In the first group are patients who have an advanced stage of cervical cancer at the time of diagnosis. The second group consists of patients who have received unsuccessful primary treatment. Over the past decade the role of surgery in the management of patients with advanced disease has been studied with a view toward a more precise extent of disease evaluation prior to definitive therapy. The potential benefit of pretreatment surgical staging of cervical cancer is considered in this article. The role of pelvic exenteration in the treatment of recurrent cervical cancer has been established for more than 30 years. In this article recent advances in the application of these procedures including better criteria for patient selection, improvement in surgical techniques, and patient rehabilitation are discussed.