Surgical morbidity associated with radical trachelectomy and radical hysterectomy

Alexander-Sefre, Farhad; Chee, N.; Spencer, Catherine; Menon, Usha; Shepherd, John H.

doi:10.1016/j.ygyno.2005.11.007

Cited by 90 publications

(59 citation statements)

References 12 publications

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“…However, radical hysterectomy has a potential risk of massive blood loss, blood transfusion, nerve or vascular injury, bladder, bowel dysfunction and lymphedema [5,7,8,9,10,11]. In certain cases of early-stage cervical cancer, the risk of parametrial invasion and lymph node metastases are accepted to be low.…”

Section: Discussionmentioning

confidence: 99%

Is It Possible to Perform Less Radical Surgery for Invasive Uterine Cervical Cancer?

Togami

Kitajima²,

Kobayashi³

et al. 2015

Gynecol Obstet Invest

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Background/Aims: A retrospective analysis was performed to evaluate the possibility of less radical surgery for early-stage invasive uterine cervical cancer without compromising the oncological outcome. Methods: The analysis was performed on 175 patients with invasive uterine cervical cancer in FIGO stage IA2-IIB, all of whom underwent primary radical hysterectomy. Relationship of tumor size with the incidence of pathologic parametrial involvement and the pelvic lymph node metastasis were investigated. Results: Fifty-one patients had tumor size ≤2 cm and 124 had tumor size >2 cm. Patients with tumor size ≤2 cm had a significantly lower incidence of parametrial invasion (p < 0.0001), lymph node metastasis (p < 0.0001), lymph vascular space involvement (p < 0.0001) and recurrence (p = 0.0002) than patients with tumor size >2 cm. Five-year relapse-free survival rate was 98 and 73%, respectively (p = 0.0004). Conclusion: It is suggested that less radical surgery may be appropriate for some cases with tumor size <2 cm.

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Section: Discussionmentioning

confidence: 99%

Is It Possible to Perform Less Radical Surgery for Invasive Uterine Cervical Cancer?

Togami

Kitajima²,

Kobayashi³

et al. 2015

Gynecol Obstet Invest

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“…There can be, however, little doubt that the surgical morbidity associated with trachelectomy is considerably less than that from radical hysterectomy as shown in another study. 19 Isthmic stenosis may require careful dilatation should a haematometra occur. 20 Of the 142 women undergoing trachelectomy, 24 have had 33 live births, and there has been one stillbirth (Table 4).…”

Section: Resultsmentioning

confidence: 99%

Challenging Dogma: Radical Conservation Surgery for Early Stage Cervical Cancer in Order to Retain Fertility

Shepherd

2009

annals

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INTRODUCTION Cervical cancer is the second commonest cancer to affect women with over half a million cases world-wide yearly. Screening programmes have reduced the incidence and death rate dramatically in Western societies. At the same time, professional and social pressures may delay child bearing such that a significant number of women will present with early stage disease, but be anxious to retain their fertility potential. Standard treatment by radical hysterectomy or radiotherapy has good results, but inevitably renders the women infertile. The rationale for extensive surgery resecting parametrium or destructive radiotherapy treating the whole pelvis in all cases of cervical cancer has been questioned. PATIENTS AND METHODS Lessons learnt from the less radical surgical approach to breast cancer can be applied to cervical cancer whilst still observing Halstead's principles of surgical oncology. Wide, local excision of early stage small tumours by radical vaginal trachelectomy combined with a laparoscopic pelvic lymphadenectomy utilises modern technology with traditional surgery. Radical vaginal trachelectomy comprises the distal half of a radical abdominal (Wertheim's) or vaginal (Schauta's) hysterectomy. An isthmic-vaginal anastomosis restores continuity of the lower genital tract after insertion of a cerclage that is necessary to maintain competence during future pregnancies. RESULTS A total of 142 cases were performed between 1994 and 2006, most (98%) in women with Stage 1B carcinoma of the cervix with a mean follow-up of 57 months. Twelve (9%) had completion treatment, 11 with chemo/radiotherapy and one radical hysterectomy. There were four recurrences (3%) among the women who did not have completion treatment, and two (18%) in those that did. There were 72 pregnancies in 43 women and 33 live births in 24 women. The 5-year accumulative pregnancy rate among women trying to conceive was 53%. Delivery was by classical caesarean section in a high-risk fetomaternal units with 8 babies (25%) born before 32 weeks. CONCLUSIONS Radical vaginal trachelectomy appears safe when performed in centres with appropriate experience of radical vaginal surgery and laparoscopic techniques. The impact of this new approach questions traditional teaching whilst preserving potential fertility in hitherto impossible circumstances.

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“…Lymphoedema and lymphocyst are more common in radical hysterectomy. According to Alexander-Sefre et al (25), certain complications are specific to RT including dysmenorrheal (24%), metrorrhagia (17%), problems with cerclage sutures (14%), dysplastic pap smears (24%), excessive vaginal discharge (14%), isthmic stenosis (10%), amenorrhea (7%), and deep dyspareunia.…”

Section: Surgical Complicationsmentioning

confidence: 99%

Trachelectomy in Early Cervical Cancer

Qudah¹,

Abu²,

Tarek³

et al. 2015

IJWHR

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IntroductionCervical cancer is a malignant neoplasm arising from cells originating in the cervix uteri. It is routinely screened by Papanicolaou's (Pap) smear and human papilloma virus (HPV) is considered as one of its etiological agents. Cervical cancer is the second most common cancer in reproductive age and its diagnosis is increasing in young age as a result of effective and widespread screening programs (1). Cervical cancer is the seventh most common cancer in developed countries. In 2004, around 30,750 new cases of invasive cervical cancer were diagnosed in Europe. In 2012, around 12,170 new cases were discovered in USA and the estimated deaths were 4,220. Unfortunately, the incidence of new cases is much more in developing countries due to inefficient screening programs (2). Due to effective and widespread screening programs and the delay in childbearing age, many women are diagnosed at a time which there is a strong demand for fertility sparing surgery (3). Radical hysterectomy and pelvic lymphadenectomy are the conventional treatment for early stage cervical cancer, but this results in loss of fertility (4). Fertility preservation is one of the most important issues to be discussed with the patient. In the last 20 years, laparascopy assisted radical vaginal trachelectomy (RVT) and radical abdominal trachelectomy have developed that have good documented long term oncological and pregnancy outcome. RVT is a fertility-sparing technique first described by Daniel Dargent in 1994 (5), involving the removal of the cervix, the parametrium, and cuff of vagina, while maintaining the patient's uterine fundus and adnexae. This procedure, in combination with a laparoscopic pelvic lymphadenectomy, is the most common and accepted fertility-sparing procedure for early cervical cancer. RVT begins with laparoscopic pelvic lymphadenectomy. The vaginal procedure is started by circumferential incision in the upper vagina. The supracervical ligament is cut, and the bladder base is mobilized. Posteriorly, the pouch of Douglas is opened and the pararectal spaces are exposed. The uterosacral ligaments are then divided. The vesicovaginal ligaments are then identified, and the paravesical spaces are entered laterally. Then the ureters and uterine arteries are identified. The cardinal ligaments are then divided. The cervix is amputated below the cervical isthmus (5,6). Although RVT associated with laparoscopic pelvic lymphadenectomy is the most used surgical procedure, radical trachelectomy (RT) may be performed either abdominally or vaginally (laparoscopic or robotic). It is estimated that around 40% of candidates for radical hysterectomy can undergo RT, but 12% of these cases will AbstractObjectives: To review the role of trachelectomy as a method of fertility preservation instead of traditional radical hysterectomy in early cervical cancer. Materials and Methods: We conducted our original study through research in PubMed for all original studies and reviews published in the last 10 years. We reviewed the data available on trach...

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Surgical morbidity associated with radical trachelectomy and radical hysterectomy

Cited by 90 publications

References 12 publications

Is It Possible to Perform Less Radical Surgery for Invasive Uterine Cervical Cancer?

Is It Possible to Perform Less Radical Surgery for Invasive Uterine Cervical Cancer?

Challenging Dogma: Radical Conservation Surgery for Early Stage Cervical Cancer in Order to Retain Fertility

Trachelectomy in Early Cervical Cancer

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