A 30-year-old nulliparous woman is diagnosed with Stage IB1 (tumour 3.5 cm) cervical squamous cell carcinoma and desires fertility preservation. The most appropriate oncologically acceptable fertility-sparing procedure is:

• A Loop excision (LLETZ) with close surveillance
• B Simple trachelectomy with bilateral pelvic lymphadenectomy
• C Conisation with repeat biopsy at 6 months
• D Radical trachelectomy (vaginal or abdominal) ✓

Explanation

Radical trachelectomy (vaginal: Dargent's procedure; or abdominal) with bilateral pelvic lymphadenectomy is the standard fertility-sparing option for Stage IA2–IB1 tumours up to 2 cm (some centres extend to 4 cm for abdominal trachelectomy). It removes the cervix, parametria, and upper vagina while preserving the uterine body. LLETZ and conisation are inadequate for stage IB disease. Simple trachelectomy does not remove parametria and is oncologically inadequate.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.