A 28-year-old woman with FIGO 2018 Stage IB1 cervical carcinoma (2 cm, squamous cell, no LVI) desires fertility preservation. The most appropriate surgical option with oncologically acceptable outcomes is:

• A Simple trachelectomy (Dargent procedure) with pelvic lymph node dissection
• B Large loop excision of transformation zone (LLETZ) with close surveillance
• C Radical hysterectomy is mandated; fertility preservation is contraindicated at this stage
• D Radical trachelectomy (vaginal or abdominal) with pelvic lymph node dissection ✓

Explanation

Radical trachelectomy (removal of the cervix with parametrium and upper vagina, with preservation of the uterine body) plus pelvic lymph node dissection is the fertility-sparing surgery of choice for early cervical cancer in women wishing to preserve fertility. Eligibility criteria include: Stage IA2–IB1, tumour size ≤2 cm, squamous/adenosquamous histology, no LVI, negative nodes. Five-year recurrence rates (5–10%) and survival are similar to radical hysterectomy in appropriately selected patients. Simple trachelectomy does not provide adequate parametrial clearance for Stage IB1.

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

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Written and medically reviewed by the StethoPrep medical team.