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Laparoscopic Radical Trachelectomy Is an Alternative to Laparotomy With Improved Perioperative Outcomes in Patients With Early-Stage Cervical Cancer
  1. Ali Kucukmetin, MD*,
  2. Ioannis Biliatis, MD*,
  3. Nithya Ratnavelu, MD*,
  4. Amit Patel, MD*,
  5. Iain Cameron, MD*,
  6. Angela Ralte, MD and
  7. Raj Naik, MD*
  1. *Northern Gynaecological Oncology Centre, and
  2. Department of Pathology, Gateshead NHS Trust, Queen Elizabeth Hospital, United Kingdom.
  1. Address correspondence and reprint requests to Ioannis Biliatis, MD, Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead NHS Trust, United Kingdom NE9 6SX. E-mail: giannisbil{at}hotmail.com.

Abstract

Objective Radical trachelectomy is an established surgical approach for managing young women with cervical cancer wishing to preserve fertility. The aim of this study was to compare perioperative outcomes between laparoscopic (LRT) and abdominal radical trachelectomy (ART).

Methods We reviewed the records of all women undergoing either LRT or ART in our institution since 2004. Demographic data, clinicopathologic data, and perioperative outcomes were collected and compared between the 2 procedures.

Results Overall, 27 women were identified. All of them had stage IB1 disease. Eleven (40.8%) women underwent LRT, whereas 16 (59.2%) women underwent ART. Age, parity, and body mass index, as well as histologic type, grade, and presence of lymphovascular space invasion were comparable between groups. The median length of the parametrial tissue removed was shorter in LRT versus ART (P = 0.022). The median blood loss and length of stay were significantly reduced in the LRT group (85 vs 800 mL, P < 0.001; and 4 versus 7 days, P = 0.003). The median operative time was longer with the laparoscopic approach (320 versus 192.5 minutes, P < 0.001). Early grade 1 to 2 postoperative morbidity (mainly high urinary residuals) was comparable between groups; however, more grade 3 and late morbidity events were recorded in the ART group.

Conclusions This first comparison study between LRT and ART for fertility preservation in women with cervical cancer shows that laparoscopy performed better in terms of blood loss and length of stay. Laparoscopic radical trachelectomy could be the preferred option for these patients; however, further studies are needed to confirm comparable survival outcomes.

  • Laparoscopic radical trachelectomy
  • Laparotomy
  • Blood loss
  • Length of stay
  • Parametrial length
  • Morbidity

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Footnotes

  • The authors declare no conflicts of interest.

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