A less radical treatment option to the fertility-sparing radical trachelectomy in patients with stage I cervical cancer.
The purpose of the two pilot studies was to determine the feasibility and safety of using less-radical fertility-preserving surgery: laparoscopic lymphadenectomy with sentinel lymph node identification (SLNI) followed by a large cone or simple trachelectomy (LAP-I protocol) and the LAP-III protocol, which includes neoadjuvant chemotherapy (NAC). LAP-I: Forty women underwent laparoscopic SLNI, frozen-section analysis, and a complete pelvic lymphadenectomy as the first step of treatment. Seven days after final histopathological processing of dissected nodes, a large cone or simple vaginal trachelectomy was performed in patients with negative nodes. Nine women had a tumor larger than 20 mm, prompting the administration of three cycles of NAC before surgery. LAP-I: Six frozen sections were positive (15%). In these cases, a type III Wertheim was immediately performed. There were no false-negative SLNs. There was one central recurrence, but after chemoradiation therapy, there was no evidence of the disease 62 months post-treatment. Twenty-four of 32 women whose reproductive ability had been maintained tried to conceive. Of these 24 women, 17 became pregnant (71% pregnancy rate). Eleven mothers gave birth to 12 children (1 at 24 weeks, 1 at 34 weeks, 1 at 36 weeks, and 9 between 37 and 39 weeks). LAP-III: Nine patients were included. In 7 of these 9 women, reproductive ability was maintained, with 3 women becoming pregnant (1 full term and 2 ongoing). SLNI improves safety in fertility-sparing surgery. Large cone or simple trachelectomy combined with laparoscopic pelvic lymphadenectomy can be a feasible method that yields a high, successful pregnancy rate. NAC followed by fertility-sparing surgery is an experimental alternative treatment for larger tumors.
Rob
Lukas
L
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Charles University Prague, 2nd Medical Faculty, Prague, Czech Republic. lukas.rob@lfmotol.cuni.cz
Pluta
Marek
M
Strnad
Pavel
P
Hrehorcak
Martin
M
Chmel
Roman
R
Skapa
Petr
P
Robova
Helena
H
D000328:Adult; D017024:Chemotherapy, Adjuvant; D005260:Female; D005298:Fertility; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision; D009367:Neoplasm Staging; D010865:Pilot Projects; D011247:Pregnancy; D011256:Pregnancy Outcome; D021701:Sentinel Lymph Node Biopsy; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*