Simple vaginal trachelectomy for early stage cervical cancer: A tertiary cancer center experience

Abstract

Objectives: Less radical fertility sparing procedures have been introduced to reduce morbidity and adverse obstetric outcome in cervical cancer. Our objective was to describe oncological and obstetric outcomes of women with early-stage cervical cancer who underwent a simple vaginal trachelectomy (SVT). Material and methods: From 01/2013 to 05/2017, 14 women underwent SVT preceded by laparoscopic pelvic lymph node dissection. Results: Patients' median age was 32 years and all of them were nulliparous. Histology included squamous cell carcinoma and adenocarcinoma in 12 (85.7%) and 2 (14.3%) patients, respectively. Three patients had stage 1A1 with lymphovascular space invasion, 4 1A2 and 7 1B1. After obtaining final histopathology, one patient underwent radical hysterectomy due to positive surgical margin and excluded from analysis. None of the patients had lymph node metastasis. None of the 13 patients developed a recurrence within a median follow-up of 27 (6-56) months. Seven patients have conceived: 4 were term deliveries, 2 were late preterm deliveries and 1 was spontaneous abortion. Conclusions: SVT in well selected early-stage cervical cancer patients seems to be a safe treatment option with excellent oncologic outcome, preserving reproductive function. Literature data will need to be confirmed in large prospective series.

Fertility-Sparing and Less Radical Surgery for Cervical Cancer

“…In this combined group, the authors found a 5-year progression-free survival of 97.9% and overall survival of 97.6%, with only one recurrence and death (2%) occurring in a patient who underwent simple trachelectomy [ 21 ]. These findings are similar to a smaller retrospective review of 14 women who underwent simple vaginal trachelectomy with no recurrences [ 22 ]. Raju et al in 2011 reviewed data from 66 women who either underwent simple vs. radical vaginal trachelectomy [ 23 ].…”

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

“…Conization procedures have been described as cold knife cone, large loop excision of the transformation zone, and laser conization [8,13,33,34,47]. Alternatively, SVT involves ligation of the bilateral descending branches of the uterine arteries, followed by amputation of the lower portion of the cervix with a 1-cm gross margin and at times including a 1-cm proximal vaginal resection [11,44,47]. Fertility is able to be preserved in 81% to 100% of the patients with this approach [34].…”

Variation in outcome reporting in studies of fertility‐sparing surgery for cervical cancer: A systematic review

“…The literature search yielded a total of 937 studies, of which 355 duplicates were removed; 582 titles were screened against our inclusion criteria, and 452 abstracts were fully assessed. Of those abstracts, 130 full texts were scrutinised, and 51 failed to meet the inclusion criteria, leaving 79 studies for inclusion in our analysis 25,38–115 . Additionally, the literature search yielded several systematic reviews, which were manually assessed, and we identified a further 25 studies not captured by the initial literature search 26,116–139 …”