Abdominal radical trachelectomy: Is it safe for IB1 cervical cancer with tumors ≥ 2 cm?
Introduction
Women with cervical cancer who have delayed childbearing often have a strong desire for fertility-preserving surgery. Radical trachelectomy (RT) is a viable option for such patients. This novel fertility-sparing surgery has become widely accepted since it was initially developed in 1987 by the French surgeon Daniel Dargent.
For oncological safety, vaginal radical trachelectomy (VRT) is generally limited to cervical cancer with a tumor size less than 2 cm. However, because abdominal radical trachelectomy (ART) can remove a wider portion of parametrial tissue than VRT, it is unclear if it would be safe to expand the ART inclusion criteria to cervical cancer patients with tumors ≥ 2 cm in size. The purpose of this article is to report our experience with ART in cervical cancer patients whose tumors are ≥ 2 cm in size and to describe the surgical and oncological outcomes.
Section snippets
Methods
With institutional review board approval, we conducted a retrospective review of a prospectively maintained database of patients undergoing fertility-sparing ART for cervical cancer at our institution from 04/2004 to 01/2013. If patients met institutional eligibility criteria, which were published previously [1], they were considered eligible for ART with a pelvic lymphadenectomy. This surgical procedure was approved by the institutional review board, and all patients who planned to undergo ART
Results
Between 04/2004 and 01/2013, a total of 133 cervical cancer patients underwent a laparotomy for a planned fertility-sparing abdominal radical trachelectomy and pelvic lymphadenectomy. Of them, 62 patients had a tumor ≥ 2 cm in size, and these 62 patients constitute our study group. Forty-six patients had their tumor size documented by a physical exam or MRI, while 16 patients had it documented on a pathology report from a cone/LEEP/trachelectomy or summation of the tumor size from the cone/LEEP
Discussion
In current gynecological oncology practice, fertility preservation has become a significant and meaningful issue when deciding on how to treat stage IA-IB cervical cancer [4]. For the first time, the 2013 NCCN cervical cancer guidelines separate the treatment of stage I cervical cancer based on the desire for fertility preservation. The guidelines also allow the inclusion of select stage IB1 lesions without a restriction on tumor diameter but with the notation that this approach is most
Conflict of interest statement
The authors have no conflicts of interest to declare.
Acknowledgments
This research is supported by the “Supporting Program for Appropriate Technology” of the Shanghai Health Bureau (SHDC12012215).
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