# Advances in the Surgical Management of Cervical Cancer

## TL;DR

This review discusses recent changes in cervical cancer surgery, focusing on less invasive techniques and better patient outcomes.

## Contribution

The paper highlights innovative surgical approaches and their impact on patient care and outcomes in cervical cancer treatment.

## Key findings

- Minimally invasive surgery may offer similar oncologic outcomes compared to traditional radical surgery.
- Sentinel lymph node mapping improves perioperative outcomes compared to systematic lymphadenectomy.
- Fertility-sparing and simple hysterectomy options are increasingly considered for early-stage cervical cancer patients.

## Abstract

This review illustrates the evolving history and the emerging landscape of surgical management in cervical cancer. Historically, standard surgical practice included a radical hysterectomy and lymphadenectomy via a laparotomy incision. Over the years, the indications for radical surgery have decreased given the increased surgical morbidity and worse quality of life. This review will highlight the innovative surgical history in cervical cancer including when a simple hysterectomy is appropriate, the consideration for minimally invasive surgery, sentinel lymph node mapping and excision, fertility-sparing when appropriate, and staging in locally advanced and pelvic exenteration, while reviewing oncologic outcomes and patient-reported outcomes. Further, this review will highlight ongoing trials.

Cervical cancer is the third most common gynecologic malignancy in the United States. Traditionally, a radical hysterectomy with bilateral salpingo-oophorectomy with lymph node assessment had been the standard of care; however, there has been a recent shift towards less radical surgery with the establishment of the oncologic safety of conization (as fertility preserving surgery), and simple hysterectomy for certain subgroups of patients with early-stage disease. In addition, uptake in the utilization of sentinel lymph node mapping, compared to systematic lymphadenectomy, has translated to improved perioperative outcomes. While laparotomy is the preferred mode of surgery for patients with cervical cancer, emerging data suggest that protective maneuvers may not compromise oncologist outcomes and multiple clinical trials are evaluating the oncologic safety of minimally invasive surgery. In this present review, we summarize recent advances in surgical management in patients with cervical cancer.