Cervical cancer surgery is a definitive treatment modality for early-stage malignant tumors of the cervix. The primary mechanism is surgical excision of cancer tissue with clear surgical margins, accompanied by pathological evaluation of pelvic pelvic lymph nodes. Depending on the International Federation of Gynecology and Obstetrics (FIGO) stage, surgical interventions are categorized into fertility-sparing procedures and radical anatomical resections. Treatment protocols follow consensus guidelines from the National Comprehensive Cancer Network (NCCN) and the European Society of Gynaecological Oncology (ESGO).

Cervical cancer surgery begins with the patient under general anesthesia in the lithotomy position. For abdominal or minimally invasive radical hysterectomy, the abdomen is insufflated or opened via midline or Pfannenstiel incision. Ureters are identified and mobilized laterally from the broad ligament. The uterine arteries are ligated at their origin from the internal iliac artery. The parametrial and uterosacral ligaments are divided at the pelvic side wall or mid-length depending on the radicality class (Querleu-Morrow classification). The upper vagina is transected, leaving a wide cuff, and the specimen is retrieved for permanent pathological margin evaluation. Pelvic lymph node dissection or sentinel lymph node (SLN) mapping using indocyanine green (ICG) is performed systematically. The vaginal cuff is closed, haemostasis verified, and a Foley catheter placed.

Cervical cancer surgery offers high rates of curative resection in early-stage disease without requiring primary radiation therapy, thereby preserving ovarian endocrine function in premenopausal patients. Radical trachelectomy allows preservation of uterine fertility in select young patients. Surgical staging provides precise pathological risk factor mapping—such as lymphovascular space invasion (LVSI), deep stromal invasion, and lymph node status—guiding post-operative adjuvant therapy decisions.

Inpatient recovery typically ranges from one to four days depending on whether open, laparoscopic, or robotic approaches are used. Initial mobilization and bladder catheter management occur during days one to five. Patients gradually resume normal physical activity within four to eight weeks postoperatively. Long-term surveillance involves pelvic exams and Pap or HPV testing every three to six months for two years, then every six to twelve months up to five years.

Cervical cancer surgery treats squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma of the uterine cervix. Specific clinical indications include FIGO early stages IA1, IA2, IB1, IB2, and select stage IIA1 lesions. It also treats persistent cervical intraepithelial neoplasia grade 3 (CIN 3) and adenocarcinoma in situ (AIS) when fertility-sparing localized excision is required.

Preoperative evaluation includes a physical pelvic examination, cervical biopsy, high-resolution pelvic magnetic resonance imaging (MRI), and chest CT or PET-CT scan to rule out distant metastasis. Patients undergo standard routine preoperative blood panels, electrocardiogram, and anesthesia consultation. Prophylactic low-molecular-weight heparin (LMWH) and sequential compression devices are initiated to prevent deep vein thrombosis. Mechanical bowel preparation may be ordered depending on surgical approach. Preadmission fasting from solids for 6 to 8 hours and clear fluids up to 2 hours prior to surgery is strictly required.

Common and mild risks include temporary urinary retention, catheter discomfort, minor incisional wound infection, and constipation. Moderate risks include lower extremity lymphoedema, prolonged bladder dysfunction requiring self-catheterisation, urinary tract infections, and vaginal cuff dehiscence. Serious but rare risks include ureteral, bladder, or bowel injury, massive pelvic hemorrhage requiring transfusion, pelvic lymphocele formation, deep vein thrombosis, pulmonary embolism, and pelvic fistula formation (ureterovaginal or vesicovaginal).

The clinical journey for cervical cancer surgery begins with diagnostic staging, physical examination under anesthesia, magnetic resonance imaging (MRI), and tissue biopsy. Preoperative optimization includes baseline laboratory assessments and multidisciplinary tumor board review. The operative phase involves general anesthesia, central tumor excision, parametrial resection, and pelvic lymph node assessment. Postoperative inpatient management focuses on pain control, bladder drainage management, early mobilization, and venous thromboembolism prevention. Long-term recovery includes pathology review, pelvic floor rehabilitation, surveillance imaging, and routine clinical examinations every three to six months.