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Fertility-Sparing Surgery for Early Cervical Cancer—Approach to Less Radical Surgery
  1. Shanti Kankipati Raju, MD, FRCOG*,
  2. Andreas John Papadopoulos, MD, MRCOG,
  3. Stephen Attard Montalto, MD. MRCOG,
  4. Michael Coutts, MAFRCPath, FRCPA,
  5. Giuseppe Culora, MAFRCPath, FRCPA§,
  6. Malik Kodampur, MRCOG,
  7. Gautam Mehra, MRCOG* and
  8. Omer Devaja, MD, MSc, PhD, MRCOG
  1. *Department of Gynaecological Oncology,
  2. §Department of CellularPathology, St Thomas’ Hospital, London, UK;
  3. Department of Gynaecological Oncology, and
  4. Department of Cellular Pathology, West Kent Cancer Centre, Maidstone Hospital, Kent, UK.
  1. Address correspondence and reprint requests to Omer Devaja, MD, MSc, PhD, MRCOG, Department of Gynaecological Oncology, West Kent Cancer Centre, Maidstone Hospital, Kent, ME16 0DU, UK. E-mail o.devaja@nhs.net.

Abstract

Objective To evaluate whether certain patients with early-stage cervical cancer are candidates for less radical surgery when considering fertility-sparing surgery.

Design Prospective cohort study.

Setting Two gynecologic cancer centers (St Thomas’ Hospital, London; and West Kent Gynaecological Cancer Centre, Maidstone).

Population Women with early-stage cervical cancer (n = 66) undergoing fertility-sparing surgery, either simple (SVT) or radical vaginal trachelectomy (RVT).

Methods Prospective clinical data collection and review of patient notes, pathology and radiology data, and pregnancy outcomes.

Main Outcome Measures Postoperative complications, surgical specimen histologic analysis, follow-up data, and obstetric outcome.

Results A total of 66 women underwent either SVT (n = 15) or RVT (n = 51), with pelvic lymphadenectomy, for stage IA2 or IB1 cervical cancer. There was no residual disease in the SVT specimen in 53% versus 29% after RVT. Clear surgical margins in 100% of SVT specimens with residual disease versus 94% after RVT. Two patients had positive lymph nodes after RVT; one of these declined adjuvant treatment until after egg harvesting and subsequently died of disease (1.5%). Median follow-up was 96 months (range, 12–120 months). One patient had a mid vaginal recurrence (1.5%). Twenty-four women have tried to conceive to date, with 14 women having 17 live births. Live birth pregnancy rate was 70.8%.

Conclusions It is possible to select patients for a less radical fertility-sparing procedure through identification of measurable low-risk factors and thus reduce the morbidity caused by conventional RVT. The selection criteria should be stringent and applied within the setting of a cancer center.

  • Trachelectomy
  • Pregnancy
  • Fertility
  • Cervical cancer

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Footnotes

  • The authors declare that there are no conflicts of interest.

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