Cervical Preservation During Hysterectomy

Indications for Cervical Preservation

The American College of Obstetricians and Gynecologists recommends radical trachelectomy with pelvic lymph node dissection for stage IA1 and IA2 cervical cancer in patients who wish to preserve fertility, and after childbearing is complete, hysterectomy can be considered for patients who had radical trachelectomy if they have chronic persistent HPV infection, persistent abnormal Pap tests, or desire this surgery 1, 2
The National Comprehensive Cancer Network recommends simple hysterectomy with postoperative radiation therapy to decrease the risk of locoregional recurrence in patients with endometrial cancer and cervical involvement, and radical hysterectomy should still be considered for patients with bulky cervical involvement if simple hysterectomy would "cut through" the tumor 3, 4

The American Cancer Society recommends against cervical preservation in cases of cervical involvement in endometrial cancer, small cell neuroendocrine tumors, or minimal deviation adenocarcinoma 3, 4, 5

The Centers for Disease Control and Prevention recommends that women who have had a total hysterectomy with removal of the cervix do not require routine Pap tests unless the hysterectomy was performed because of cervical cancer or its precursor lesions, and women with a supracervical hysterectomy must continue routine cervical cancer screening 6, 7

Women who have had a total hysterectomy with removal of the cervix for benign disease do not require routine Pap tests, as recommended by the American Cancer Society, based on guidelines from Ca-A Cancer Journal for Clinicians 8, 9
Women who have had a hysterectomy for cervical intraepithelial lesions should continue screening until three documented, consecutive, technically satisfactory normal/negative vaginal cytology tests and no abnormal/positive cytology tests within a 10-year period are achieved, according to guidelines from Ca-A Cancer Journal for Clinicians 8
Women with a history of in utero DES exposure and/or with a history of cervical carcinoma should continue screening after hysterectomy for as long as they are in reasonably good health, as recommended by Ca-A Cancer Journal for Clinicians 8

Women with preserved cervix require ongoing cervical cancer screening, unlike those who undergo total hysterectomy for benign disease, as stated in Ca-A Cancer Journal for Clinicians 8