Vaginal approaches to fertility-sparing surgery in invasive cervical cancer.

There is an important proportion of reproductive-age patients with early stage cervical cancer, low risk of parametrial or lymph node invasion and 95% overall survival rate at 5 years. Actually, there are two conservative techniques for fertility preservation for which long-term follow-up data consistently show acceptable overall and recurrence-free survival rates: conization and vaginal radical trachelectomy (VRT) (Dargent' s operation). Conization is optimal for women with stage IA1 disease without lymphvascular space invasion, and Dargent' s operation is optimal for women with stage IA2 and IB1 disease who have tumors <or=2 cm in diameter. Other criteria are age <or=40 years, a desire to preserve fertility, and negative lymph nodes. In other techniques like conization or simple trachelectomy with lymphadenectomy selection of patients with low -risk factors is essential; no vascular space invasion and stromal invasion <or=1 cm are required. Sentinel node mapping and biopsy are good predictors of node metastasis and could be a good method to select patients for conservative parametrial and cervical surgery. Neoadjuvant chemotherapy could be useful in women with stage IB1 tumors 2 -4 cm in diameter with >or=50% stromal invasion with or without lymphovascular invasion.