A 35-year-old woman desires fertility preservation. Cervical biopsy reveals squamous cell carcinoma. Pelvic MRI shows a 1.8 cm tumour confined to the cervix with no parametrial invasion and no lymph node involvement. Which procedure offers the best oncological and fertility-preserving outcome?
- A Large loop excision of transformation zone (LLETZ) with close follow-up
- B Simple trachelectomy without lymphadenectomy
- C Radical trachelectomy with pelvic lymph node dissection ✓
- D Neoadjuvant chemotherapy followed by cone biopsy
Correct answer: C. Radical trachelectomy with pelvic lymph node dissection
Explanation
Radical trachelectomy (vaginal, abdominal, or robotic) combined with pelvic lymph node dissection is the standard fertility-sparing procedure for FIGO Stage IB1 cervical carcinoma ≤2 cm (some centres accept up to 2 cm). It removes the cervix, parametria, upper vagina while preserving the uterine body. The 5-year recurrence-free survival is comparable to radical hysterectomy in selected cases. Pregnancy rates of ~50–70% have been reported. LLETZ is insufficient for invasive cancer. Simple trachelectomy lacks parametrial excision and adequate margins.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.