ReviewSurgical, oncological, and obstetrical outcomes after abdominal radical trachelectomy — A systematic literature review
Introduction
The standard recommendation for the treatment of patients with early-stage cervical cancer (stages IA2–IB1) is radical hysterectomy or, for those interested in preserving fertility, radical trachelectomy [1].
In 1994, Dargent et al. [2] were the first to report on the utility of vaginal radical trachelectomy (VRT) with laparoscopic lymph node dissection for the treatment of early-stage cervical cancer. Since that time, more than 900 cases of VRT have been reported, establishing the obstetrical and oncological outcomes of this procedure [3], [4], [5], [6], [7], [8], [9], [10], [11]. Radical trachelectomy can also be done entirely laparoscopically [12], [13] or by robotic approach [14], [15], [16], but for these approaches, the number of reported cases is low and the follow-up times are too short to permit conclusions regarding the procedures' safety.
In 1997, Smith et al. published the first report of abdominal radical trachelectomy (ART) [17]. Since then, several authors have reported on the safety and feasibility of this procedure [16], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45]. The advantages of ART include the reproducibility of the technique, the fact that the procedure can be performed without training in radical vaginal surgery and requires no laparoscopic equipment, and the wider parametrial resection than can be achieved with abdominal radical trachelectomy. However, the oncological and obstetrical outcomes of ART are not well established. The aim of this review was to evaluate the surgical, oncological, and obstetrical outcomes of all reported cases of ART.
Section snippets
Methods
We performed a systematic review of the English-language literature on fertility-sparing surgery in patients with cancer of the uterine cervix. The MEDLINE, EMBASE, and CINAHL databases were searched for articles published during the period from 1997 through 2012. The terms used in the search were uterine cervix neoplasms, early cervical cancer, abdominal radical trachelectomy, vaginal radical trachelectomy, fertility sparing, and fertility preservation. Reference lists of all articles
Results
The 29 articles included in this review were 12 reports of case series, which included a total of 460 patients, and 17 case reports that included 25 patients. Thus, this review includes information on 485 patients who underwent ART (Fig. 1). Demographic and tumor information is summarized in Table 1. The patients ranged in age from 6 to 44 years. The most common histologic subtype was squamous cell carcinoma (331/470; 70%), and the second most common was adenocarcinoma (110/470; 23%). The
Discussion
The findings of this review indicate that ART is a reproducible and safe procedure for treating early cervical cancer in women who wish to preserve their fertility. The surgical and oncological outcomes were very favorable. ART was associated with similar pregnancy rates to those reported for VRT (16% vs. 24%).
We found that the intraoperative complication rate for ART (0.7%) was lower than the rate previously reported for VRT (5.6%) in other large series [8]. The rate of postoperative
Conflict of interest statement
The authors declare that there are no conflicts of interest.
Acknowlegement
The authors would like to thank Ms. Stephanie Deming for her editorial assistance.
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