A 36-year-old woman with Stage IB2 cervical squamous cell carcinoma (4.2 cm) desires fertility preservation. Which statement about radical trachelectomy in this setting is MOST accurate?
- A Abdominal radical trachelectomy (ART) is not feasible for tumors > 4 cm and is contraindicated
- B Neoadjuvant chemotherapy followed by abdominal trachelectomy is a validated strategy for tumors 2–4 cm ✓
- C Vaginal radical trachelectomy (VRT) allows fertility preservation with acceptable recurrence rates for tumors < 2 cm but carries significant risk for tumors 2–4 cm
- D The cervical stump after trachelectomy retains full competence without cerclage requirement
Explanation
For tumors between 2–4 cm, neoadjuvant chemotherapy (NACT) — typically paclitaxel and cisplatin — followed by abdominal radical trachelectomy has been evaluated in several case series and is an emerging option for tumors too large for standard VRT but where fertility is desired. The GOG reported data on this approach; isthmic cerclage placement at time of trachelectomy is standard, as the reconstructed cervix lacks structural competence. VRT (vaginal approach with laparoscopic lymphadenectomy) carries higher recurrence risk for tumors > 2 cm, hence the shift toward ART or NACT-ART. The cervical isthmus always requires cerclage regardless of approach.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.