A 28-year-old nulliparous woman with Stage IA2 squamous cell carcinoma of cervix (stromal invasion 4.5 mm, horizontal spread 6 mm) desires fertility preservation. The most appropriate surgical option that provides adequate margins while preserving fertility is:

• A Large loop excision of transformation zone (LLETZ/LEEP) with negative margins
• B Cold knife conization with 5 mm clear margins
• C Radical trachelectomy (vaginal or abdominal) with pelvic lymph node dissection ✓
• D Simple trachelectomy (removal of cervix only) without lymphadenectomy

Explanation

Stage IA2 cervical carcinoma (invasion >3 mm up to 5 mm) with desire for fertility preservation is best managed by radical trachelectomy (vaginal/abdominal) with pelvic lymph node dissection (sentinel node or complete dissection). Radical trachelectomy removes the cervix with parametria and upper vagina while preserving the uterine corpus — it provides parametrial clearance analogous to radical hysterectomy. It has excellent oncologic outcomes with recurrence rates <5% and successful pregnancy rates of 50–70%. LEEP or cone biopsy (A, B) are adequate only for Stage IA1 without LVSI; Stage IA2 requires parametrial assessment. Simple trachelectomy (D) does not provide parametrial margins needed for IA2 disease.

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

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Written and medically reviewed by the StethoPrep medical team.