A 30-year-old woman with Stage IB1 (FIGO 2018; tumour 2.5 cm) cervical squamous cell carcinoma wishes to preserve fertility. She has no lymphovascular space invasion (LVSI) and negative sentinel nodes on intraoperative assessment. The MOST appropriate fertility-sparing surgery is:

• A Cone biopsy with pelvic lymph node dissection
• B Radical trachelectomy (vaginal or abdominal) with pelvic lymphadenectomy ✓
• C Simple trachelectomy with laparoscopic sentinel node biopsy only
• D Large loop excision of transformation zone (LLETZ) followed by adjuvant chemotherapy

Explanation

Radical trachelectomy (removal of cervix, parametrium, and upper vagina with preservation of the uterine corpus) with pelvic lymphadenectomy is the standard fertility-sparing surgery for early-stage cervical cancer (typically Stage IB1 with tumour ≤2 cm in most traditional criteria; some centres extend to ≤4 cm). For tumours of 2.5 cm with negative LVSI, radical trachelectomy is appropriate. Simple trachelectomy or cone biopsy are acceptable only for tumours ≤2 cm with no LVSI in selected patients. LLETZ is inadequate for invasive carcinoma beyond stage IA1.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.