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Use of Abdominal Radical Trachelectomy to Treat Cervical Cancer Greater Than 2 cm in Diameter
  1. Balazs Lintner, MD*,
  2. Srdjan Saso, BSc, MRCS,
  3. Laszlo Tarnai, MD*,
  4. Zoltan Novak, MD*,
  5. Laszlo Palfalvi, PhD, MD*,
  6. Giuseppe Del Priore, MD, MPH,
  7. J. Richard Smith, MD, FRCOG§ and
  8. Laszlo Ungar, PhD, MD*
  1. *Consultant in Gynaecological Oncology, Department of Gynaecologic Oncology, St Stephen Hospital, Budapest, Hungary;
  2. Clinical Research Fellow, Division of Surgery and Cancer, Institute of Reproductive& Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom;
  3. Mary Fendrich Hulman Professor of Gynaecologic Oncology, Indiana University, Indianapolis, IN; and
  4. §Consultant Gynaecological Surgeon, West London Gynaecological Cancer Centre, Queen Charlotte’s Hospital, Hammersmith Hospital Campus, Imperial College London, United Kingdom.
  1. Address correspondence and reprint requests to Laszlo Ungar, PhD, MD, Department of Gynaecologic Oncology, St Stephen Hospital, 1051 Budapest, Hungary. E-mail: laszlo.ungar@googlemail.com.

Abstract

Objective Invasive cervical cancer is one of the most common cancers, with 500,000 new cases diagnosed annually. Fertility preservation has become an important component of the overall quality of life of many cancer survivors. Expert opinion has suggested that fertility-sparing surgery should be limited to those patients diagnosed with cervical cancer less than 2 cm in diameter. Our objective was to report our abdominal radical trachelectomy (ART) experience in the opposite group of patients—those with a cervical cancer more than 2 cm in diameter.

Methods Between 1999 and 2006, a total of 45 patients with cervical carcinoma at International Federation of Gynecology and Obstetrics stage IB1-IB2 measuring more than 2 cm in diameter underwent fertility-sparing ART and pelvic lymphadenectomy at the 3 institutions where the authors are based (Budapest, Hungary; London, United Kingdom; New York, United States). They were followed up for more than 5 years.

Results For 69% of patients (n = 31), completed ART was considered to have been curative, and no adjuvant treatment was advised. Of those patients, 93.5% (n = 29) were alive at the time of follow-up. Thirty-one percent of patients (n = 14) underwent immediate completion of radical hysterectomy. Three of 8 patients who wished to fall pregnant delivered healthy neonates.

Conclusions The 5-year survival rate (93.5%) for this case series is equal (or better) to rates reported in the literature for patient treated with radical hysterectomy. Our survival data seem to support the hypothesis that ART is a safe treatment option for patients with invasive cervical cancer lesions of more than 2 cm.

  • Early-stage cervical cancer
  • Radical hysterectomy
  • Abdominal radical trachelectomy
  • 2-cm diameter

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Footnotes

  • No financial support or funding was received for this study.

  • In the United Kingdom, approval to perform ART was granted by the Institute Review Board of the Chelsea and Westminster Hospital Ethics Committee in 1997, which is where it was first performed. Approval to collect data regarding ART patients was granted by the Quality and Safety Coordinator for the Women’s and Children’s Clinical Programme Group at Queen Charlotte’s Hospital. No formal approval was required to collect data in Budapest and the United States.

  • Contribution to authorship: B.L., L.T., and S.S. were responsible for the original manuscript design, drafting, and revision for important intellectual content. B.L., Z.N., and L.T. were responsible for data collection. L.P., J.R.S., and G.D.P. were responsible for providing important intellectual content throughout the manuscript’s production, drafting parts of the manuscript, and for final approval of the version to be published. L.U. is the guarantor for this article and accepts full responsibility for the work and/or the conduct of the study. His involvement was critical to every phase of this work, and he controlled the decision to publish.

  • L.U., J.R.S., and G.D.P. are the coinventors of the ART technique.

  • The authors declare no conflicts of interest.

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