The vaginal radical trachelectomy: An update of a series of 125 cases and 106 pregnancies
Research Highlights
►VRT offers excellent oncology outcome and preserves fertility in most patients. ►Lesions > 2 cm are associated with a higher risk of recurrence.
Introduction
With childbearing being one of the most important goals in life, fertility preservation has become a very important component of the overall quality of life of young cancer survivors. Neglected for a long time, the issue of fertility preservation is receiving more attention and is now studied in a more comprehensive way. In 2006, the American Cancer Society has made recommendations to encourage physicians to discuss fertility issues in reproductive age cancer patients prior to initiating cancer treatments [1]. The psychosocial impact of cancer-related infertility in women treated for gynecologic malignancies is significant with a high proportion of these women experiencing feelings of depression, grief, stress and sexual dysfunction [2], [3]. Recent data confirms that the emotional and physical impact of impaired or loss of fertility can be long lasting [4].
The most common cancers in women aged less than 40 are breast cancer, melanoma, cervical cancer, non-Hodgkin's lymphoma and leukemia [5]. According to the SEER data, up to 42% of all cervical cancers are diagnosed in women prior to the age of 45 [6]. Data from the Sloan-Kettering indicate that up to 40% of women who have undergone a radical hysterectomy at their center would have been eligible for a radical trachelectomy [7]. Therefore, particularly in countries where cervical cancer screening is in place, a significant proportion of cervical cancer is diagnosed at an early stage, frequently in women aged less than 40, such that a significant proportion of these patients may be interested in a treatment modality that preserves fertility without jeopardizing oncologic outcome.
The radical trachelectomy is now an accepted treatment modality for the surgical management of early-stage cervical cancer in women wishing to preserve fertility. The oncologic and obstetrical results that have accumulated over the last 2 decades have confirmed a recurrence rate < 5% and promising obstetrical results [8].
We have previously reported our oncologic and obstetrical results in our first 72 patients and our first 50 pregnancies [9], [10]. We now report on a larger cohort of 140 patients including 106 pregnancies. We wish to summarize our experience and provide key figures for clinicians when counseling patients interested in this procedure and for patients in order to have realistic expectations when considering this fertility-preserving option.
Section snippets
Material and methods
This is a prospective series of 140 consecutive planned vaginal radical trachelectomies in women with a diagnosis of early-stage cervical cancer wishing to preserve their fertility potential over an 18-year period, from October 1991 to March 2010. All records were kept prospectively in a computerized database. The technique of the vaginal radical trachelectomy has been described thoroughly elsewhere [11].
All patients were aware that the trachelectomy procedure could be abandoned if metastatic
Patients and tumor characteristics
A VRT was offered to 140 women with early-stage cervical cancer during an 18-year period but the procedure was actually performed in 125 (89%). The median age was 31 (range: 20–42). Table 1 summarizes tumor characteristics, with comparison between patients who had the planned trachelectomy and patients who did not. The majority of patients (69%) had stage IB1 disease and 21% had stage IA2 disease. Only 7 patients (5%) had stage IA1 disease but all had vascular space invasion, and 3 had stage
Oncologic outcome
We report one of the largest single institution series of vaginal radical trachelectomies. Compared to our previous report, tumor characteristics are largely unchanged except for a 4% increase in the proportion of adenocarcinomas, 8% more LVSI and 8% more stage IB1 (Table 1). Morbidity of the procedure remains low (5.7%) (Table 2) and compares favorably with data reported in other series [13], [14], [15].
Conflict of interest statement
The authors declare that there are no conflicts of interest.
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