Cervical cancer Cervix surgery & treatment Dr Jérémie Zeitoun · Surgeon Paris 8th

What it is. Conisation removes a small cone-shaped portion of the cervix — where the lesion is located. The uterus, ovaries and everything else are preserved.

When it is proposed. For high-grade precancerous lesions (CIN 2-3) and the very earliest stages of cancer (when the tumour is very small and superficial, stage IA1 without lymphovascular invasion).

How it works. The procedure takes 20 to 30 minutes under general anaesthesia. It is day surgery: you come in the morning and go home the same evening. No abdominal incision.

Recovery. A few days of light bleeding are normal. You are asked to avoid baths and tampons for 3 to 4 weeks. Return to usual activities within about a week.

What about fertility? After conisation, pregnancies are entirely possible. Enhanced monitoring during pregnancy is recommended.

What it is. Multiple high conisations remove the suspicious areas of the cervix while preserving the uterine body. This operation treats the cancer while keeping the possibility of pregnancy.

When it is proposed. For small tumours in patients wishing to preserve fertility. Saint-Paul de Vence 2025 guidelines specify that this fertility-sparing cervical surgery, when extended to the parametria, must be performed in an expert centre. Pre-therapeutic conisation helps better define the situation: tumour size, depth of stromal invasion, presence of lymphovascular emboli.

Sentinel lymph node biopsy is associated. The pelvic sentinel lymph node is sampled in the same operative session to verify there is no spread to the lymph nodes. If the sentinel node is healthy, fertility-sparing surgery can continue.

Recent evolution: SHAPE 2024 trial. This major international trial (published in the New England Journal of Medicine) showed that for tumours with favourable prognosis — less than 2 cm, low cervical wall infiltration on MRI (less than 50%), depth of stromal invasion below 10 mm — simple hysterectomy without parametrial removal gives equivalent results to radical surgery, with fewer urinary and sexual complications. This simplification is now a validated option for eligible patients according to Saint-Paul de Vence 2025 guidelines.

And pregnancies after? Pregnancies are possible after this type of conservative surgery. The risk of preterm delivery is higher: enhanced obstetric follow-up and planned caesarean section are organised.

What it is. Total colpo-hysterectomy removes the entire uterus (body + cervix) and a vaginal cuff. Depending on cancer stage and MRI findings, it may be extended to the parametria — the ligaments that hold the uterus in the pelvis. The pelvic lymph nodes are also sampled for analysis.

When it is proposed. When the tumour is larger, when fertility-sparing surgery is not possible or not desired. The exact extent of the operation (with or without parametrial extension) is decided at the multidisciplinary team meeting based on MRI findings.

How it works. The operation lasts 2 to 3 hours under general anaesthesia, through a lower abdominal incision (discreet horizontal scar, similar to caesarean). Precision surgery preserving pelvic nerves as much as possible to avoid urinary disturbances afterwards. Sentinel lymph node sampling is usually associated with the main operation.

Will I keep my ovaries? In the vast majority of cases, especially before age 50, yes — the ovaries can be preserved. Cervical cancer does not spread to the ovaries at operable stages. Keeping the ovaries avoids surgical menopause. According to Saint-Paul de Vence 2025 guidelines, ovarian preservation is discussed for women of childbearing age, with a tumour less than 4 cm, of squamous cell carcinoma type or HPV-related adenocarcinoma. Ovarian transposition (moving the ovaries out of the radiation field) may be offered if radiotherapy is planned.

Hospital stay. 4 to 6 days. Return to normal activity within 4 to 6 weeks. Bladder rehabilitation is sometimes necessary.

After the operation. Depending on pathology results, complementary radiotherapy may be recommended. This is not systematic — it depends on what the results show.

What it is for. When cancer spreads, it first travels through the pelvic lymph nodes. The sentinel node is the first lymph node the cancer would reach if it were spreading. We analyse it during the operation: if it is healthy, the others are very probably also healthy — and we don't remove them. This avoids extensive lymphadenectomy and its complications.

Why it matters. Removing many lymph nodes can cause lymphoedema (swollen legs due to disrupted lymphatic circulation). The sentinel lymph node technique greatly reduces this risk.

How it is done. A small amount of fluorescent dye (indocyanine green) is injected into the cervix at the start of the operation. This dye travels to the sentinel node, which becomes visible under a special light. We remove and analyse it immediately during the operation.

Saint-Paul de Vence 2025 guidelines. Sentinel lymph node biopsy is now the reference technique for small cervical tumours. It must be performed by a trained team (at least 15 procedures per year), with ICG detection. In case of identification failure, a new injection or a limited ipsilateral lymphadenectomy is performed.

What happens depending on the result. If the node is healthy, we don't remove the others. If the node contains cancer cells, lymphadenectomy (removal of more nodes) is performed in the same operative session — or sometimes surgery is interrupted in favour of radio-chemotherapy, depending on context.

→ See the full page on pelvic sentinel lymph node — detailed procedure, indications, recovery, comparison with classic lymphadenectomy.