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Nerve-Sparing Radical Abdominal Trachelectomy Versus Nerve-Sparing Radical Hysterectomy in Early-Stage (FIGO IA2-IB) Cervical Cancer: A Comparative Study on Feasibility and Outcome
  1. Mignon Dingena Johanna Maria van Gent, MD,
  2. Lukas Wesley van den Haak, MD,
  3. Katja Nicolien Gaarenstroom, MD, PhD,
  4. Alexander A. W. Peters, MD, PhD,
  5. Mariette Inie Elisabeth van Poelgeest, MD, PhD,
  6. Johanes Baptist Maria Zacharias Trimbos, MD, PhD and
  7. Cor Doede de Kroon, MD, PhD
  1. Leiden University Medical Center, Leiden, the Netherlands.
  1. Address correspondence and reprint requests to Mignon Dingena Johanna Maria van Gent, MD, Gynaecology, Leiden University Medical Center, K6-P, Postbus 9600, 2300 RC Leiden, the Netherlands. E-mail: m.d.j.m.van_gent{at}lumc.nl.

Abstract

Objectives Standard treatment in early-stage cervical cancer is a radical hysterectomy (RH) with pelvic lymphadenectomy. In women who wish to preserve fertility radical vaginal trachelectomy has been proposed; however, this is not feasible in larger tumors, and nerve-sparing surgery is not possible. Nerve-sparing radical abdominal trachelectomy (NSRAT) overcomes these disadvantages.

Methods Case-control study of women with early-stage cervical cancer (International Federation of Gynecology and Obstetrics IA2-IB) submitted to NSRAT from 2000 until 2011. Women submitted to nerve-sparing RH with early-stage cervical cancer were included as control subjects.

Results Twenty-eight patients and 77 control subjects were included. Neoadjuvant chemotherapy was administered in 3 women before NSRAT because the linear extension was or exceeded 40 mm. Local recurrence rate was 3.6% (95% confidence interval [CI], 0.00–10.6) in the NSRAT group compared with 7.8% (95% CI, 1.7–13.9) in the control group (P = 0.44). No significant difference was found between both groups regarding disease-free survival and survival. The overall pregnancy rate was 52.9% (95% CI, 28.7%–77.2%). The mean follow-up was 47.3 months (range, 6–122 months) for NSRAT and 51.8 months (11–129.6 months) for nerve-sparing RH.

Conclusions Nerve-sparing radical abdominal trachelectomy seems safe and effective in women with early-stage cervical cancer who wish to preserve fertility. Respective women should be informed about this treatment option, especially if the tumor is too large for radical vaginal trachelectomy.

  • Cervical cancer
  • Fertility preservation
  • Radical surgery
  • Pregnancy
  • Survival
  • Neoadjuvant chemotherapy

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Footnotes

  • There has been no financial support or funding from any organization.

  • The authors declare no conflicts of interest.

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