title: Fertility-sparing surgery for early cervical cancer-approach to less radical surgery.
abstract: OBJECTIVE
  To evaluate whether certain patients with early-stage cervical cancer are candidates for less radical surgery when considering fertility-sparing surgery.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Two gynecologic cancer centers (St Thomas' Hospital, London; and West Kent Gynaecological Cancer Centre, Maidstone).
  
  
  METHODS
  Women with early-stage cervical cancer (n = 66) undergoing fertility-sparing surgery, either simple (SVT) or radical vaginal trachelectomy (RVT).
  
  
  METHODS
  Prospective clinical data collection and review of patient notes, pathology and radiology data, and pregnancy outcomes.
  
  
  METHODS
  Postoperative complications, surgical specimen histologic analysis, follow-up data, and obstetric outcome.
  
  
  RESULTS
  A total of 66 women underwent either SVT (n = 15) or RVT (n = 51), with pelvic lymphadenectomy, for stage IA2 or IB1 cervical cancer. There was no residual disease in the SVT specimen in 53% versus 29% after RVT. Clear surgical margins in 100% of SVT specimens with residual disease versus 94% after RVT. Two patients had positive lymph nodes after RVT; one of these declined adjuvant treatment until after egg harvesting and subsequently died of disease (1.5%). Median follow-up was 96 months (range, 12-120 months). One patient had a mid vaginal recurrence (1.5%). Twenty-four women have tried to conceive to date, with 14 women having 17 live births. Live birth pregnancy rate was 70.8%.
  
  
  CONCLUSIONS
  It is possible to select patients for a less radical fertility-sparing procedure through identification of measurable low-risk factors and thus reduce the morbidity caused by conventional RVT. The selection criteria should be stringent and applied within the setting of a cancer center.
authors.affiliation: Department of Gynaecological Oncology, St Thomas' Hospital, London, UK.
authors.forename: Shanti Kankipati
authors.initials: SK
authors.lastname: Raju
authors.forename: Andreas John
authors.initials: AJ
authors.lastname: Papadopoulos
authors.forename: Stephen Attard
authors.initials: SA
authors.lastname: Montalto
authors.forename: Michael
authors.initials: M
authors.lastname: Coutts
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Culora
authors.forename: Malik
authors.initials: M
authors.lastname: Kodampur
authors.forename: Gautam
authors.initials: G
authors.lastname: Mehra
authors.forename: Omer
authors.initials: O
authors.lastname: Devaja
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D018196:Carcinoma, Adenosquamous / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D004739:England; D005260:Female; D005298:Fertility; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D009367:Neoplasm Staging; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult