Abdominal radical trachelectomy in fertility-sparing treatment of early-stage cervical cancer.
BACKGROUND
Abdominal radical trachelectomy (ART) is one of the fertility-sparing procedures in women with early-stage cervical cancer. In comparison with vaginal radical trachelectomy, the published results of ART are so far limited.


METHODS
Enrolled were women referred for ART either by laparoscopy or laparotomy. The main inclusion criterion was stage IA2 or IB1 with a cranial extent that allows for preservation of at least 1 cm of the endocervical canal.


RESULTS
A total of 24 women were referred for the procedure, but fertility could not be preserved in 7 (29%) of them. Four women underwent immediate completion of radical hysterectomy because of a positive cranial surgical margin (n = 2) or sentinel node macrometastasis (n = 2) on frozen section. We found no correlation between tumor volume and inability to preserve fertility. A positive sentinel node was identified in 4 patients (17%); there were no false-negative results. Of the 9 women (53%) who have tried to conceive so far, 6 (67%) have conceived and 5 given birth, 2 of which were premature deliveries.


CONCLUSIONS
Fertility cannot be preserved because of positive cranial margins or involved lymph nodes in almost one third of patients originally referred for radical trachelectomy. The main criterion for the selection of suitable patients should be the cranial extent of the tumor. Abdominal radical trachelectomy allows for achievement of satisfactory obstetrical outcomes.
Cibula
David
D
Oncogynecological Center, Department of Obstetrics and Gynecology, General Teaching Hospital, First Medical School, Charles University, Prague, Czech Republic. david.cibula@iol.cz
Sláma
Jiri
J
Svárovský
Jiri
J
Fischerova
Daniela
D
Freitag
Pavel
P
Zikán
Michal
M
Pinkavová
Iva
I
Pavlista
David
D
Dundr
Pavel
P
Hill
Martin
M
D000005:Abdomen / Q000473:pathology / Q000601:surgery*; D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D005260:Female; D005298:Fertility; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007044:Hysterectomy; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*