title: Fertility-sparing surgery in early-stage cervical cancer: indications and applications.
abstract: This article describes the surgical and pathologic findings of fertility-sparing radical trachelectomy using a standardized surgical technique, and reports the rate of posttrachelectomy outcomes. The authors analyzed a prospectively maintained database of all patients with FIGO stage IA1-IB1 cervical cancer admitted to the operating room for planned fertility-sparing radical abdominal trachelectomy. Sentinel node mapping was performed through cervical injection. Between November 2001 and May 2010, 98 consecutive patients with FIGO stage IA1-IB1 cervical cancer and a median age of 32 years (range, 6-45 years) underwent a fertility-sparing radical trachelectomy. The most common histology was adenocarcinoma in 54 patients (55%) and squamous carcinoma in 42 (43%). Lymph-vascular invasion was seen in 38 patients (39%). FIGO stages included IA1 (with lymph-vascular invasion) in 10 patients (10%), IA2 in 9 (9%), and IB1 in 79 (81%). Only 15 (15%) needed immediate completion radical hysterectomy because of intraoperative findings. Median number of nodes evaluated was 22 (range, 3-54), and 16 (16%) patients had positive pelvic nodes on final pathology. Final trachelectomy pathology showed no residual disease in 44 (45%) cases, dysplasia in 5 (5%), and adenocarcinoma in situ in 3 (3%). Overall, 27 (27%) patients needed hysterectomy or adjuvant pelvic radiation postoperatively. One (1%) documented recurrence was fatal at the time of this report. Cervical adenocarcinoma and lymph-vascular invasion are common features of patients selected for radical trachelectomy. Most patients can undergo the operation successfully with many having no residual invasive disease; however, nearly 27% of all selected cases will require hysterectomy or postoperative chemoradiation for oncologic reasons. Investigation into alternative fertility-sparing adjuvant therapy in patients with node-positive disease is needed.
authors.affiliation: Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York. gynbreast@mskcc.org
authors.forename: Nadeem R
authors.initials: NR
authors.lastname: Abu-Rustum
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sonoda
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005298:Fertility; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult