Fertility-sparing surgery for cervical cancer
Surgical treatment for cervical cancer can be performed by conization (partial removal of the cervix) or by trachelectomy (removal of the entire cervix and preservation of the uterine body).
These operations are performed under strict indications and require good coordination between the oncologist and the gynecologist.
Cervical conization is a surgical intervention in which the affected part of the cervix is removed in the form of a cone.
It can be classical intervention (with a scalpel), LLETZ procedure (large loop excision of the transformation zone), LEEP procedure (loop electrical excision procedure) or procedure by laser.
When the ultimate goal is preserving fertility, loop or laser conization is preferred to classical conization.
Conization is most appropriate for the earliest stages of the disease – stages IA1 and IA2.
In some cases, conization is accompanied by additional surgical evaluation of the pelvic lymph nodes (by sentinel lymph node biopsy or pelvic lymph node dissection).
Trachelectomy is a surgical intervention, wherein the entire cervix is removed, but the body of the uterus is preserved, allowing the pregnancy to be carried to term.
The procedure also involves the application of cerclage (a non-resorbable thread that reduces the risk of miscarriage or premature birth).
Trachelectomy is appropriate for early stages of the disease, including stages up to IB1 (tumors up to 2 cm). Tumors larger than 2 cm are not suitable for fertility-sparing surgery due to the significant increase in risk for the patient.
The procedure must include immediate surgical evaluation of the pelvic lymph nodes, prior to removal of the cervix. All this happens during single surgical procedure, as the detection of affected lymph nodes makes the use of fertility-sparing surgery impossible.
In more advanced stages of the disease (≥IB3 stage, i.e., tumors greater than 4 cm; tumors affecting surrounding structures in the pelvis; cases with affected lymph nodes), surgical treatment gives way to definitive radiation chemotherapy. Unfortunately, this method does not allow the preservation of fertility.