Elsevier

Gynecologic Oncology

Volume 131, Issue 1, October 2013, Pages 77-82
Gynecologic Oncology

Review
Surgical, oncological, and obstetrical outcomes after abdominal radical trachelectomy — A systematic literature review

https://doi.org/10.1016/j.ygyno.2013.06.010Get rights and content

Highlights

  • Abdominal radical trachelectomy is associated with excellent oncologic outcomes.

  • Pregnancy rates are similar to those of vaginal radical trachelectomy.

  • Most frequent complication after abdominal radical trachelectomy is cervical stenosis.

Abstract

Objective

Radical trachelectomy is a standard treatment for selected patients with early-stage cervical cancer. Outcomes are well established for vaginal radical trachelectomy (VRT), but not for abdominal radical trachelectomy (ART).

Methods

We searched MEDLINE, EMBASE, and CINAHL (October 1997 through October 2012) using the terms: uterine cervix neoplasms, cervical cancer, abdominal radical trachelectomy, vaginal radical trachelectomy, fertility sparing, and fertility preservation. We included original articles, case series, and case reports. Excluded were review articles, articles with duplicate patient information, and articles not in English.

Results

We identified 485 patients. Ages ranged from 6 to 44 years. The most common stage was IB1 (331/464; 71%), and the most common histologic subtype was squamous cell carcinoma (330/470; 70%). Operative times ranged from 110 to 586 min. Blood loss ranged from 50 to 5568 mL. Three intraoperative complications were reported. Forty-seven patients (10%) had conversion to radical hysterectomy. One hundred fifty-five patients (35%) had a postoperative complication. The most frequent postoperative complication was cervical stenosis (n = 42; 9.5%). The median follow-up time was 31.6 months (range, 1–124). Sixteen patients (3.8%) had disease recurrence. Two patients (0.4%) died of disease. A total of 413 patients (85%) were able to maintain their fertility. A total of 113 patients (38%) attempted to get pregnant, and 67 of them (59.3%) were able to conceive.

Conclusion

ART is a safe treatment option in patients with early-stage cervical cancer interested in preserving fertility.

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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