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Surgery for cervical cancer: consensus & controversies.

Pabashi Poddar1, Amita Maheshwari1

  • 1Division of Gynecologic Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.

The Indian Journal of Medical Research
|December 2, 2021
PubMed
Summary

The standard surgical treatment for early cervical cancer is open radical hysterectomy. While less invasive options are emerging, definitive chemoradiation is preferred for advanced stages.

Keywords:
Early-stage cervical cancerfertility preservationminimal invasive surgeryneoadjuvant chemotherapyovarian preservationradical surgery

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Area of Science:

  • Gynecologic Oncology
  • Surgical Oncology
  • Radiation Oncology

Background:

  • Surgery is a cornerstone in treating early-stage cervical cancer.
  • Open radical hysterectomy with pelvic lymph node dissection is the established standard.
  • Evidence does not support minimally invasive radical hysterectomy for cervical cancer.

Purpose of the Study:

  • To review current surgical management strategies for cervical cancer.
  • To evaluate emerging surgical techniques and their evidence base.
  • To outline treatment standards for early and advanced cervical cancer stages.

Main Methods:

  • Review of level I evidence regarding surgical approaches.
  • Analysis of data on neoadjuvant chemotherapy (NACT) and its impact on survival.
  • Evaluation of fertility-sparing and less-radical surgical options.

Main Results:

  • Open radical hysterectomy is supported by level I evidence; laparoscopic/robotic approaches are not recommended for radical hysterectomy.
  • Sentinel lymph node biopsy and nerve-sparing surgery show promise in selected early-stage patients.
  • Definitive concurrent chemoradiation is superior to NACT followed by surgery for locally advanced cervical cancer.

Conclusions:

  • Standard treatment for early cervical cancer remains open radical hysterectomy.
  • Neoadjuvant chemotherapy followed by surgery is inferior to chemoradiation for advanced stages.
  • Fertility-sparing and less-radical surgeries are under investigation for specific patient groups.