Surgical treatment of locally advanced and recurrent cervical carcinoma: overview on current standard and new developments

The current standard treatment of locally advanced carcinoma of the uterine cervix is chemoradiation. Whether new developments such as laparoscopic surgical staging or neoadjuvant systemic and regional chemotherapy, preoperative chemoradiation and intraoperative radiation combined with radical hysterectomy will improve recurrence- free and overall survival is yet unproven. Until recently, surgical treatment of locally advanced and recurrent cervical carcinoma was performed only with a central disease location. The required operation, pelvic exenteration, was contraindicated for tumors fixed to the pelvic wall. The laterally extended endopelvic resection (LEER) now allows the exstirpation of a subset of mesenteric pelvic side-wall tumors with clear margins and opens up a 50% chance of long-term survival for the affected patients.