title: Fertility conserving management of early cervical cancer: our experience of LLETZ and pelvic lymph node dissection.
abstract: BACKGROUND
  Presently, for those diagnosed with early cervical cancer who wish to conserve their fertility, there is the option of radical trachelectomy. Although successful, this procedure is associated with significant obstetric morbidity. The recurrence risk of early cervical cancer is low and in tumors measuring less than 2 cm; if the lymphatics are negative, the likelihood of parametrial involvement is less than 1%. Therefore, pelvic lymph nodes are a surrogate marker of parametrial involvement and radical excision of the parametrium can be omitted if they are negative.
  
  
  OBJECTIVE
  The aim of this study was to report our experience of the fertility conserving management of early cervical cancer with repeat large loop excision of the transformation zone and laparoscopic pelvic lymph node dissection.
  
  
  METHODS
  Between 2004 and 2011, a retrospective review of cases of early cervical cancer who had fertility conserving management within Glasgow Royal Infirmary was done.
  
  
  RESULTS
  Forty-three patients underwent fertility conserving management of early cervical cancer. Forty were screen-detected cancers; 2 were stage IA1, 4 were stage IA2, and 37 were stage IB1. There were 2 central recurrences during the follow-up period. There have been 15 live children to 12 women and there are 4 ongoing pregnancies.
  
  
  CONCLUSIONS
  To our knowledge, this is the largest case series described and confirms the low morbidity and mortality of this procedure. However, even within our highly select group, there have been 2 cases of central recurrent disease. We, therefore, are urging caution in the global adoption of this technique and would welcome a multicenter multinational randomized controlled trial.
authors.affiliation: *Department of Gynaecological Oncology, Princess Royal Maternity Hospital, Glasgow Royal Infirmary; and †Department of Pathology, Southern General Hospital, Glasgow, United Kingdom.
authors.forename: Rhona
authors.initials: R
authors.lastname: Lindsay
authors.forename: Kevin
authors.initials: K
authors.lastname: Burton
authors.forename: Smruta
authors.initials: S
authors.lastname: Shanbhag
authors.forename: Jenny
authors.initials: J
authors.lastname: Tolhurst
authors.forename: David
authors.initials: D
authors.lastname: Millan
authors.forename: Nadeem
authors.initials: N
authors.lastname: Siddiqui
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D002584:Cervix Uteri / Q000473:pathology; D004598:Electrosurgery / Q000009:adverse effects; D005260:Female; D005298:Fertility; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult