A 35-year-old woman with FIGO Stage IA2 cervical squamous cell carcinoma (3.8 mm depth, 6 mm width) desires fertility preservation. What is the most appropriate surgical management?

• A Simple hysterectomy
• B Cold knife conisation alone
• C Modified radical hysterectomy (Wertheim's)
• D Radical trachelectomy with pelvic lymph node dissection ✓

Explanation

Stage IA2 (3–5 mm depth, ≤7 mm width) with desire for fertility preservation is best managed by radical trachelectomy (removal of cervix and parametria with uterine conservation) combined with pelvic lymph node dissection. Cold knife conisation is adequate for IA1 without LVSI. Simple hysterectomy does not include parametrial dissection adequate for IA2. Modified radical hysterectomy sacrifices fertility and is not preferred when preservation is feasible.

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

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