Chapter 20 - Fertility-saving surgery for cervical cancer

Summary

Patients with early cervical cancer (FIGO stage IB1 or less) are conventionally considered treated with a surgical approach while those with more advanced disease are treated by radiotherapy with concurrent chemotherapy. Dargent's operation is the realization of a laparoscopic pelvic lymph-node dissection associated with a radical cervical amputation through a vaginal approach. Dargent's operation or radical trachelectomy enables preservation of fertility among women with early cervical cancer. The benefits of Dargent's operation are linked to the laparoscopic approach, which reduces the risk of adhesions on pelvis organs and the vaginal route that allows the preservation of uterine body and its optimal vascularization. Following the excellent results achieved by the Dargent's operation, several teams have proposed operating variants through laparotomy or laparoscopy. These modifications are subject to criticism because they are usually associated with the section of the uterine arteries and, thus, with a partial devascularization of the uterus.