Laparoscopic Operative Staging in Cervical Cancer

Cancer of the uterine cervix is still one of the most common cancers among women worldwide with approximately 530,000 new cases and 275,000 deaths in 2008 [1]. Cervical cancer classically occurs in young patients with a mean age of 45 years, resulting in a potential loss of 26 years of life per affected individual [1, 2]. Unfortunately, about 60% of these cases are diagnosed with advanced disease and are no longer candidates for primary curative surgery. In countries with high resources, total incidence of invasive cervical cancer is decreasing due to effective screening with a shift toward earlier stages of disease [2]. However, percentage of patients with FIGO stages ≥IIB stagnates over years in many countries. This is probably due to women who never made use of screening programs. In Germany percentages of stages II, III, and IV are 25%, 8%, and 6% with 5-year survival of 71%, 51%, and 16%, respectively [3]. Between 2005 and 2008 in Beijing, distribution of FIGO stages II, III, and IV was 26%, 18% and 6%, respectively, mainly in unemployed women and housewives, farmers, and urban low-income people [4]. There is also a higher risk for cervical cancer for older and/or uninsured people in the USA [5]. Socioeconomic situation influences probability for cervical cancer with higher risk for short-educated, older women living without partners in Denmark, as demonstrated by Ibfelt et al. [6]. Therefore therapy of cervical cancer in locally advanced stage is still a relevant problem.