Analysis of a continuous series of 34 young patients with early-stage cervical cancer selected for a vaginal radical trachelectomy: should "staging" conization be systematically performed before this procedure?
OBJECTIVE
Vaginal radical trachelectomy (VRT) is the most widely evaluated form of conservative management of young patients with early-stage (IB1) cervical cancer. Patients with nodal involvement or a tumor size greater than 2 cm are not eligible for such treatment. The aim of this study is to report the impact of a "staging" conization before VRT.


METHODS
This is a retrospective study of 34 patients potentially selected for VRT for a clinical and radiologic cervical tumor less than 2 cm. Among them, 28 underwent finally a VRT (20 of them having a previous conization before this procedure) and 6 patients with macroscopic cervical cancer, confirmed by punch biopsies, "eligible" for VRT (<2 cm) had undergone "staging" conization (without further VRT) to confirm the tumor size and lymphovascular space involvement (LVSI) status.


RESULTS
Six patients having "staging" conization before VRT had finally been deemed contraindications to VRT due to the presence of a histologically confirmed tumor greater than 2 cm and/or associated with multiple foci of LVSI. Among 28 patients who underwent VRT, 1 received adjuvant chemoradiation (this patient recurred and died of disease). Two patients treated with RVT (without postoperative treatment) recurred. Ten pregnancies (9 spontaneous and 1 induced) were observed in 9 patients. Among 4 patients with macroscopic "visible" tumor who do not underwent a "staging" conization before VRT, 2 recurred. Among 11 patients who underwent VRT and having LVSI, 3 recurred.


CONCLUSIONS
These results suggest that if a conization is not performed initially, it should then be included among the staging procedures to select patients for VRT.
Department of Gynecologic Surgery, Unit INSERM U 10-30, Institut Gustave Roussy, Villejuif, France. catherine.uzan@igr.fr
Catherine
C
Uzan
Sebastien
S
Gouy
Delphine
D
Desroque
Christophe
C
Pomel
Pierre
P
Duvillard
Corrine
C
Balleyguier
Christine
C
Haie-Meder
Philippe
P
Morice
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D019092:Conization / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005298:Fertility / Q000502:physiology; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000379:methods; D009367:Neoplasm Staging / Q000009:adverse effects / Q000379:methods; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*