Abstract: Objective To investigate the clinical effect of preoperative neoadjuvant chemotherapy on patients with stageⅠB2 orⅡA2 cervical cancer and its impact on pathological morphology changes. Methods Ninety-two elderly patients with cervical cancer who were treated in the Second Hospital of Nanjing and Maternity Hospital of Nanjing Medical University from January 2012 to January 2017 were selected as the research subjects. According to the treatment scheme, the patients were divided into neoadjuvant chemotherapy group and direct operation group. The direct operation group received extensive hysterectomy under general anesthesia combined with pelvic lymph node and para aortic lymph node resection, while the neoadjuvant chemotherapy group received paclitaxel plus cisplatin chemotherapy before receiving surgical treatment. The treatment efficacy, operating time, intraoperative blood loss, complications and postoperative pathologic morphology changes of the two groups were compared. Results Neoadjuvant chemotherapy was effective in 75% patients, which was significantly higher than that of the direct operation group (45.45%) (P<0.05). The intraoperative blood loss in the direct operation group was significantly higher than that in the neo-adjuvant chemotherapy group (P<0.05). In the direct operation group, the incidence of the cancer infiltration, intravascular invasion and pelvic lymph node metastasis were all significantly higher than those of the neoadjuvant chemotherapy group (P<0.05). However, there was no significant difference in operative time, postoperative complications and the incidence of para uterine infiltration between the direct operation group and the neoadjuvant chemotherapy group (P>0.05). Conclusion Preoperative neoadjuvant chemotherapy is effective in improving the clinical outcomes for stage ⅠB2 and stage ⅡA2 cervical cancer in elderly patients.