Patient-tailored conservative surgical treatment of invasive uterine cervical squamous cell carcinoma. A review.
The aim of this paper was to review currently available data regarding the results of a more conservative, patient-tailored surgical approach in selected cases of early invasive uterine squamous cell carcinoma (SCC). A PubMed search of investigations in the English language published from January 2000 to September 2012 containing the terms conservative surgery, conservative treatment, trachelectomy, parametrectomy, lymphadenectomy, sentinel lymph node biopsy and fertility sparing surgery in combination with SCC was made. Conization only is optimal for women with stage Ia1 disease mainly in tumors without lymph vascular space involvement (LVSI). In stage Ib1 patients interested to maintain reproductive capacity, vaginal or abdominal radical trachelectomy are the procedures of choice. Patients with small tumors (<2 cm), no deep invasion, no LVSI, and negative pelvic nodes are at very low risk of parametrial involvement and parametrectomy may be omitted in them. Such patients may benefit from less radical surgery and may be candidates for simple hysterectomy, simple trachelectomy, or conization with pelvic lymphadenectomy. Sentinel lymph node (SLN) biopsy is apparently a good predictor of node metastases and allows the performance of lymphadenectomy only in SLN positive cases. Thus lymphadenectomy may also be omitted in some patients. In young women with locally advanced tumors, neoadjuvant chemotherapy followed by fertility-sparing surgery may also be a feasible treatment. A more conservative, patient-tailored surgical approach in selected cases of early SCC is possible resulting in lower morbidity and preservation of fertility without compromising the outcome.
Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel - joseph12@internet-zahav.net.
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Menczer
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D019092:Conization / Q000379:methods; D005260:Female; D059247:Fertility Preservation; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D057285:Precision Medicine / Q000379:methods*; D021701:Sentinel Lymph Node Biopsy; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D055815:Young Adult