Objective There is a trend towards less radical surgery in women with small volume disease who wish to preserve fertility. The objective of our study was to evaluate the oncologic and obstetrical outcome of simple vaginal trachelectomy (SVT) and node assessment in patients with low-risk early-stage cervical cancer (< 2 cm).
Methods From May 2007 to January 2020, 50 women underwent a SVT/conisation with laparoscopic SLN mapping + pelvic node dissection. Data was collected prospectively in a computerized database. Descriptive statistics and Kaplan-Meyer estimate were used for analysis.
Results Patients’ median age was 29 and 35 (70%) were nulliparous. Eleven had stage IA1 with LVSI, 13 IA2 and 26 IB1 (52%). Twenty-six (52%) had squamous histology and 20 (40%) adenocarcinoma. On final pathology, lymph nodes were negative in 46 patients (92%), 3 had isolated tumor cells and one micrometastasis. Thirty patients (60%) had either no residual disease in the trachelectomy specimen (22) or residual dysplasia only (8). With a median follow-up of 76 months (1–140), there was only one recurrence. The 5-year progression-free and overall survival are 97.9% and 97.6% respectively. There were 40 pregnancies: 5 (12.5%) ended in the first trimester, one in second trimester and only 3 (7.5%) were late preterm (34.4, 35 and 35 weeks); all the others (30 or 75%) delivered > 36 weeks and one pregnancy is ongoing.
Conclusion Based on our experience, simple trachelectomy and nodes is an oncologically safe fertility-preserving surgery in well-selected patients with small volume cervical cancer. Obstetrical outcome is excellent.
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