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      Less radical surgery for women with early stage cervical cancer: Our experience on radical vaginal trachelectomy and laparoscopic pelvic lymphadenectomy

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          Abstract

          We report the use of radical vaginal trachelectomy (RVT) with pelvic laparoscopic lymphadenectomy (LPL) in patients with early stages cervical cancer (FIGO stage IA2-IB1). This is a case series prospectively collected over a 6-year period (2011–2017) at the Ipswich hospital, UK. Cases were compared to a group of women with a similar stage of cervical cancer, but treated with radical hysterectomy (RH) and pelvic lymphadenectomy (PL). A total of 19 patients (group 1) underwent RVT and LPL, and 51 (group 2) had RH and PL. We included: 5/19 (26%) stage IA2 and 14/19 (74%) stage IB1. Among those, we had: 12/19 (63%) cases of squamous cell carcinoma (SCC), 7/19(37%) of adenocarcinoma. Mean hospital stay was 2.7 days (range 2–4) in group 1 versus 4.8 days (range 3–8) group 2 ( p-value = 0.173). The complication rate was not statistically different between the two groups 4/19(21%) and 7/51(14%) ( p-value 0.169). The mean follow-up period was 47.3 months (range 7–78) in both groups. There were no cases of recurrence in group 1 and 2/51(4%) cases in group 2, but the difference was not significant ( p-value = 0.497). In our experience RVT in well-selected patients is a safe treatment option with similar oncological outcomes when compared to patients undergoing more extensive surgery for the same early stage cervical cancer.

          Highlights

          • •

            Less radical surgery in women with early cervical cancer is a safe surgical alternative.

          • •

            Large trials are warranted to reconsider management of early stages cervical cancer in young women.

          • •

            We report similar outcomes between radical hysterectomy and fertility sparing surgery.

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          Cancer incidence and mortality among young adults aged 20–39 years worldwide in 2012: a population-based study

          Miranda M Fidler, Sumit Gupta, Isabelle Soerjomataram … (2017)
          To date, the burden of cancer among young adults has rarely been studied in depth. Our aim was to describe the scale and profile of cancer incidence and mortality worldwide among 20-39 year-olds, highlighting major patterns by age, sex, development level, and geographical region.
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            Oncological outcomes after fertility-sparing surgery for cervical cancer: a systematic review.

            Enrica Bentivegna, Sébastien Gouy, Amandine Maulard … (2016)
            Fertility preservation in young patients with cervical cancer is suitable only for patients with good prognostic factors and disease amenable to surgery without adjuvant therapy. Consequently, it is only offered to patients with early-stage disease (stage IB tumours 2 cm) and lymphovascular space invasion status are two main factors to determine the best fertility-sparing surgical technique. In this systematic Review, we assess six different techniques that are available to preserve fertility (Dargent's procedure, simple trachelectomy or cone resection, neoadjuvant chemotherapy with conservative surgery, and laparotomic, laparoscopic and robot-assisted abdominal radical trachelectomy). The choice between the six different fertility preservation techniques should be based on the experience of the team, discussion with the patient or couple, and, above all, objective oncological data to balance the best chance for cure with optimum fertility results for each procedure.
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              Laparoscopic vaginal radical trachelectomy: a treatment to preserve the fertility of cervical carcinoma patients.

              P Mathevet, X Martin, D Dargent … (2000)
              Cervical carcinoma occurs frequently in young women who would like to preserve their childbearing potential. For those with early stage invasive lesions, the authors designed and performed radical trachelectomy, a surgical procedure that preserves the functions of the uterus. Radical trachelectomy combines laparoscopic (for pelvic lymphadenectomy) and transvaginal approaches. Between April 1987 and December 1996, 56 patients were scheduled for this procedure, and 47 underwent it. The charts of these patients were retrospectively reviewed for medical and obstetric history, characteristics and complications of surgical procedures, pathologic findings, postoperative obstetric results, and cancer recurrences. The mean durations of the laparoscopic and vaginal steps of the procedure were 62 and 67 minutes, respectively. One intraoperative complication (cystotomy) and seven postoperative complications (drainage of pelvic collection) were observed. The pathologic tumor classification was International Union Against Cancer (UICC) pT1a1 (International Federation of Gynecology and Obstetrics [FIGO] Stage pIA1) in 5 cases, UICC pT1a2 (FIGO Stage pIA2) in 13 cases, UICC pT1b (FIGO Stage pIB) in 25 cases, UICC pT2a (FIGO Stage pIA2) in 1 case, and UICC pT2b (FIGO pIIB) in 3 cases. The mean follow-up was 52 months. Two recurrences (4%) were observed (one lateropelvic and one distant), and one patient died of disease progression. Despite a 25% rate of late miscarriages, 13 normal children were born after radical trachelectomy. In young patients affected by early invasive cervical carcinoma, radical trachelectomy does not appear to increase the rate of recurrence. It carries a relative risk of infertility and late miscarriage but makes it possible for some patients to become pregnant and give birth to normal newborns. Thus, it seems reasonable to offer this procedure in selected cases, provided that each patient is fully informed and the surgeon properly trained. Copyright 2000 American Cancer Society.
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                Author and article information

                Contributors
                I. Rizzuto
                Journal
                Journal ID (nlm-ta): Gynecol Oncol Rep
                Journal ID (iso-abbrev): Gynecol Oncol Rep
                Title: Gynecologic Oncology Reports
                Publisher: Elsevier
                ISSN (Electronic): 2352-5789
                Publication date PMC-release: 11 March 2019
                Publication date Collection: May 2019
                Publication date (Electronic): 11 March 2019
                Volume: 28
                Pages: 65-67
                Affiliations
                East Suffolk and North Essex NHS Trust, Ipswich NHS Trust, Gynecological Oncology Department, Heath Road, IP4 5PD Ipswich, Suffolk, England, UK
                Author notes
                [* ]Corresponding author. ivana.rizzuto@ 123456icloud.com
                Article
                Publisher ID: S2352-5789(19)30027-X
                DOI: 10.1016/j.gore.2019.03.005
                PMC ID: 6416726
                SO-VID: 690783cb-c53d-4abc-8663-544ac5820554
                Copyright © © 2019 The Author(s)
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 4 February 2019
                Date revision received : 3 March 2019
                Date accepted : 6 March 2019
                Categories
                Subject: Case Series

                Keywords: early stage cervical cancer,trachelectomy,fertility sparing surgery
                Data availability:
                Keywords: early stage cervical cancer, trachelectomy, fertility sparing surgery

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