Radical trachelectomy: a fertility-sparing option for early invasive cervical cancer.
For the past 15 years gynecological oncologists have been seeking ways to preserve woman's fertility when treating invasive cervical cancer. For some women with small localized invasive cervical cancers, there is now hope for pregnancy after treatment. Many cases of cervical cancer are diagnosed in young woman who wish to preserve their fertility. As more women are delaying childbearing, fertility preservation has become an important consideration. The standard surgical treatment for stage IA2-IB1 cervical cancer is a radical hysterectomy and bilateral pelvic lymphadenectomy. This surgery includes removal of the uterus and cervix, radical resection of the parametrial tissue and upper vagina, and complete pelvic lymphadenectomy. Obviously, the standard treatment does not allow future childbearing. Radical trachelectomy is a fertility-sparing surgical approach developed in France in 1994 by Dr. Daniel Dargent for the treatment of early invasive cervical cancer. Young women wishing to bear children in the future may be candidates for fertility-preservation options. The radical trachelectomy operation has been described and performed abdominally, assisted vaginally by laparoscopy and robotically. In this review we discuss the selection criteria for radical trachelectomy, the various possible techniques for the operation, the oncological and obstetric outcomes, and common complications.
Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center (Ein Kerem Campus), Jerusalem, Israel.
Javier
J
Mejia-Gomez
Tomer
T
Feigenberg
Tomer
T
Feigenber
Sagit
S
Arbel-Alon
Liron
L
Kogan
Abraham
A
Benshushan
D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000517:prevention & control*; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012371:Robotics; D012404:Round Ligament of Uterus / Q000601:surgery; D013524:Surgical Flaps; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*