PLACE OF SURGERY IN THE TREATMENT OF ADVA NCED CERVICAL-CANCER

Surgical resection of advanced nonmetastatic forms of cervical cancers is controversial, but improve local control. The local and regional s taging assessment, comprising an examination under general anaesthesia , endocavitary ultrasonography, computed tomography (CT) and/or magnet ic resonance imaging (MRI) allows staging, evaluation of the main prog nostic factors and selection of the therapeutic strategy. Pelvic and l umboaortic lymph nodes can be investigated by CT, MRI or laparoscopic lymphadenectomy. Surgical resections consist of colpohysterectomy poss ibly combined with radical lymphadenectomy or pelvic exenteration, fol lowed by pelvic reconstruction using various procedures: low colorecta l anastomosis, continent urinary diversion, and vaginal reconstruction with pelvic filling. The mortality and morbidity of pelvic exenterati on remain high. it is therefore important to prevent the most frequent complications as effectively as possible. The local control, overall survival and recurrence-free survival can be improved by combining con comitant radiotherapy-chemotherapy and large surgical resection. Some unfavourable local situations can justify palliative pelvic exenterati on in highly selected indications designed to improve local control an d comfort of survival.