Clinical Recommendation Radical Trachelectomy for Fertility Preservation in Patients With Early-Stage Cervical Cancer
- 1 May 2012
- journal article
- review article
- Published by BMJ in International Journal of Gynecologic Cancer
- Vol. 22 (4), 659-666
- https://doi.org/10.1097/igc.0b013e3182466a0e
Abstract
Radical trachelectomy (RT) is a fertility-sparing procedure with the aim to provide adequate oncological safety to patients with cervical cancer while preserving their fertility. In the current review, indications, development of the procedure, technical aspects, preoperative and postoperative management, and oncological, fertility, and obstetric outcomes are discussed and studied with respect to whether the procedure is performed abdominally or vaginally. Complications of RT, staging, and more conservative alternatives to RT are discussed as well. A systematic MEDLINE search was performed, which yielded 218 articles, of which 75 were selected for further analysis based on the number of patients and the quality of the study. Strict morphologic criteria should be applied to the candidates to maintain oncological safety. When limited to a tumor less than 2 cm in diameter, the overall recurrence rate after vaginal RT is 3% to 6% and the death rate is 2% to 5%. Data on fertility and obstetric outcome are mostly based on the results of patients who underwent vaginal RT. More data are needed to be able to draw the same conclusions for abdominal RT. Fertility seems not to be decreased, but the risk for premature delivery is 2 to 3 times higher compared to women with an intact cervix. In locally advanced cervical tumors with a diameter larger than 2 cm, neoadjuvant chemotherapy followed by RT may be offered after explaining the experimental nature to the patient. In conclusion, RT is an oncologically safe technique in women with early invasive cancer. The rate of term pregnancies still needs improvement. Fertility-preserving treatment of women with tumors larger than 2 cm in diameter can be done by combining neoadjuvant chemotherapy and trachelectomy; however, experience is still limited. Copyright © 2012 by IGCS and ESGOKeywords
This publication has 25 references indexed in Scilit:
- Radical Vaginal Trachelectomy (RVT) Combined With Laparoscopic LymphadenectomyInternational Journal of Gynecologic Cancer, 2011
- Neoadjuvant chemotherapy and conservative surgery for stage IB1 cervical cancerGynecologic Oncology, 2008
- Vaginal radical trachelectomy: An updateGynecologic Oncology, 2008
- Oncological safety of laparoscopic-assisted vaginal radical trachelectomy (LARVT or Dargent’s operation): A comparative study with laparoscopic-assisted vaginal radical hysterectomy (LARVH)Gynecologic Oncology, 2007
- Surgery Insight: radical vaginal trachelectomy as a method of fertility preservation for cervical cancerNature Clinical Practice Oncology, 2007
- Radical vaginal trachelectomy (RVT) combined with laparoscopic pelvic lymphadenectomy: Prospective multicenter study of 100 patients with early cervical cancerGynecologic Oncology, 2006
- Radical trachelectomyAustralian and New Zealand Journal of Obstetrics and Gynaecology, 2006
- Vaginal radical trachelectomy: an oncologically safe fertility-preserving surgery. An updated series of 72 cases and review of the literatureGynecologic Oncology, 2004
- Laparoscopic vaginal radical trachelectomyCancer, 2000
- Role of MR Imaging in the Selection of Patients with Early Cervical Carcinoma for Fertility-preserving Surgery: Initial ExperienceRadiology, 1999