Radical vaginal versus abdominal trachelectomy for stage IB1 cervical cancer: a comparison of surgical and pathologic outcomes.
OBJECTIVE
To compare the surgical and pathologic outcomes utilizing two surgical approaches for fertility-sparing radical trachelectomy in patients with stage IB1 cervical cancer.


METHODS
A prospectively maintained database of vaginal radical trachelectomy (VRT) and abdominal radical trachelectomy (ART) procedures was analyzed. All procedures were performed in a standardized manner by the same surgical group. Parametrial measurements were recorded from the final pathology report. Standard statistical tests were used.


RESULTS
Between 12/2001 and 7/2007, 43 adult patients with FIGO stage IB1 cervical cancer underwent surgery with the intent to perform a fertility-sparing radical trachelectomy. VRT was attempted in 28 patients (65%) and ART in 15 patients (35%). The median measured parametrial length in the VRT group was 1.45 cm compared to 3.97 cm in the ART group, P<0.0001. None of the parametrial specimens in the VRT group contained parametrial nodes. Parametrial nodes were detected in 8 (57.3%) of the ART specimens (P=0.0002). There was no difference in histologic subtypes, lymph vascular space invasion, or median total regional lymph nodes removed in the two groups. Median blood loss was greater but not clinically significant in the ART group, and median operating time was less in the ART group. The overall complication rate was not significantly different in the two groups.


CONCLUSIONS
Using standardized techniques, radical abdominal trachelectomy provides similar surgical and pathologic outcomes with possibly a wider parametrial resection, including contiguous parametrial nodes, as compared to the radical vaginal approach.
Einstein
Margaret H
MH
Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Park
Kay J
KJ
Sonoda
Yukio
Y
Carter
Jeanne
J
Chi
Dennis S
DS
Barakat
Richard R
RR
Abu-Rustum
Nadeem R
NR
D000005:Abdomen / Q000601:surgery; D000328:Adult; D005260:Female; D005298:Fertility; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D014621:Vagina / Q000601:surgery; D055815:Young Adult