Perioperative morbidity of radical trachelectomy with lymphadenectomy in early-stage cervical cancer: a French prospective multicentric cohort

Balaya, Vincent; Lécuru, Fabrice; Ngô, Charlotte; Huchon, Cyrille; Bats, Anne Sophie; Mathevet, Patrice

doi:10.3802/jgo.2019.30.e34

Cited by 15 publications

(11 citation statements)

References 26 publications

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“…Of the 5598 screened articles, 153 met the predefined inclusion criteria and were assessed for their quality ( Figure 1 ) [ 8 , 14 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ,…”

Section: Resultsmentioning

confidence: 99%

Fertility-Sparing Surgery in Gynecologic Cancer: A Systematic Review

Schuurman

Zilver

Samuels

et al. 2021

Cancers

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Fertility-sparing surgery (FSS) is increasingly being offered to women with a gynecological malignancy who wish to preserve fertility. In this systematic review, we evaluate the best evidence currently available on oncological and reproductive outcome after FSS for early stage cervical cancer, epithelial ovarian cancer, and endometrial cancer. An extensive literature search was conducted using the electronic databases Medline (OVID), Embase, and Cochrane Library to identify eligible studies published up to December 2020. In total, 153 studies were included with 7544, 3944, and 1229 patients who underwent FSS for cervical, ovarian, and endometrial cancer, respectively. We assessed the different FSS techniques that are available to preserve fertility, i.e., omitting removal of the uterine body and preserving at least one ovary. Overall, recurrence rates after FSS are reassuring and therefore, these conservative procedures seem oncologically safe in the current selection of patients with low-stage and low-grade disease. However, generalized conclusions should be made with caution due to the methodology of available studies, i.e., mostly retrospective cohort studies with a heterogeneous patient population, inducing selection bias. Moreover, about half of patients do not pursue pregnancy despite FSS and the reasons for these decisions have not yet been well studied. International collaboration will facilitate the collection of solid evidence on FSS and the related decision-making process to optimize patient selection and counseling.

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Section: Resultsmentioning

confidence: 99%

Fertility-Sparing Surgery in Gynecologic Cancer: A Systematic Review

Schuurman

Zilver

Samuels

et al. 2021

Cancers

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“…1) [5]. The study designs included 27 purely retrospective [6−31], 1 retrospective on the basis of prospective trials [32], and 25 prospective observational or prospective database studies [33−57].…”

Section: Primary Study Characteristicsmentioning

confidence: 99%

“…The surgical interventions included vaginal radical trachelectomy (VRT, N = 19) [2,7,9,18,21,26,32,35,36,38,42,43,[45][46][47][48]51,54,55], abdominal radical trachelectomy (ART, N = 15) [2,6,10,14,16,19,[22][23][24]27,28,30,39,52,53], minimally invasive radical trachelectomy (MIS-RT, N = 9) (laparoscopic radical trachelectomy [LRT], N = 7; robotic radical trachelectomy, N = 2) [12,17,20,26,27,29,32,37,45] and simple vaginal trachelectomy [SVT] or conization, (N = 15) (SVT, N = 6; cone, N = 6; both, N = 3) [8,11,13,15,25,33,34,40,41,44,47,49,50,56−58]. Neoadjuvant chemotherapy (NACT) was used primarily in 6 studies, followed by SVT or cone (N = 2), VRT (N = 1), or ART (N = 1) [23,31,38...…”

Section: Primary Study Characteristicsmentioning

confidence: 99%

Fertility-Sparing Surgery for Early-Stage Cervical Cancer: A Systematic Review of the Literature

Kuznicki¹,

Chambers²,

Morton³

et al. 2021

Journal of Minimally Invasive Gynecology

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Objective: This systematic review aimed to evaluate oncologic and reproductive outcomes after fertility-sparing surgery (FSS) for early-stage cervical cancer (early CC). Data Sources: Ovid MEDLINE, Ovid EMBASE, and Cochrane CENTRAL were searched from 1980 to the present using Medical Subject Headings terms; other controlled vocabulary terms; and keywords related to fertility, cervical cancer, and surgical techniques. Methods of Study Selection: A total of 2415 studies were screened, with 53 studies included. Studies reporting recurrences with a median follow-up of 12 months in early CC (International Federation of Gynecology and Obstetrics 2009 stages IA with lymphovascular space invasion, IB, or IIA) of traditional histologic type undergoing FSS were included. Tabulation, Integration, and Results: The studies were grouped by intervention, including vaginal radical trachelectomy (VRT), abdominal radical trachelectomy (ART), minimally invasive radical trachelectomy (MIS-RT), and conization or simple trachelectomy (ST), and studies involving neoadjuvant chemotherapy (NACT). Combined rates of recurrence (RR), cancer death (CDR), pregnancy (PR), and live birth (LBR) were calculated per procedure on the basis of all included studies that reported outcomes on that procedure. The results were as follows:

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“…In addition, a two-step approach may lead to potential difficulties in terms of organization (two general anesthesia, two operating room slots) and increased costs. This has to be balanced with the benefits of an avoided radical surgery with less blood loss, less transfusion, less complications and, therefore, less increased costs associated with complications [ 37 , 38 ]. Patients could benefit from a same-day discharge conization and SLN mapping, followed by an ambulatory simple hysterectomy or trachelectomy [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Nomogram Predicting the Likelihood of Parametrial Involvement in Early-Stage Cervical Cancer: Avoiding Unjustified Radical Hysterectomies

Benoit¹,

Balaya

Guani

et al. 2020

JCM

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Background: We aimed to establish a tool predicting parametrial involvement (PI) in patients with early-stage cervical cancer and select a sub-group of patients who would most benefit from a less radical surgery. Methods: We retrospectively reviewed patients from two prospective multicentric databases—SENTICOL I and II—from 2005 to 2012. Patients with early-stage cervical cancer (FIGO 2018 IA with lympho-vascular involvement to IIA1), undergoing radical surgery (hysterectomy or trachelectomy) with bilateral sentinel lymph node (SLN) mapping with no metastatic node or PI on pre-operative imaging, were included. Results: In total, 5.2% patients (11/211) presented a histologic PI. After univariate analysis, SLN status, lympho-vascular space invasion, deep stromal invasion and tumor size were significantly associated with PI and were included in our nomogram. Our predictive model had an AUC of 0.92 (IC95% = 0.86–0.98) and presented a good calibration. A low risk group, defined according to the optimal sensitivity and specificity, presented a predicted probability of PI of 2%. Conclusion: Patients could benefit from a two-step approach. Final surgery (i.e. radical surgery and/or lymphadenectomy) would depend on the SLN status and the probability PI calculated after an initial conization with bilateral SLN mapping.

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Perioperative morbidity of radical trachelectomy with lymphadenectomy in early-stage cervical cancer: a French prospective multicentric cohort

Cited by 15 publications

References 26 publications

Fertility-Sparing Surgery in Gynecologic Cancer: A Systematic Review

Fertility-Sparing Surgery in Gynecologic Cancer: A Systematic Review

Fertility-Sparing Surgery for Early-Stage Cervical Cancer: A Systematic Review of the Literature

Nomogram Predicting the Likelihood of Parametrial Involvement in Early-Stage Cervical Cancer: Avoiding Unjustified Radical Hysterectomies

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