title: Simple vaginal trachelectomy in early-stage low-risk cervical cancer: a pilot study of 16 cases and review of the literature.
abstract: OBJECTIVE
  This study aimed to evaluate the feasibility of simple vaginal trachelectomy and node assessment in patients with low-risk early-stage cervical cancer (<2 cm).
  
  
  METHODS
  From May 2007 to November 2012, 16 women with low-risk small-volume cervical cancer underwent a simple vaginal trachelectomy preceded by laparoscopic sentinel node mapping plus or minus pelvic node dissection. Data were collected prospectively in a computerized database. Descriptive statistics and Kaplan-Meyer estimate were used for analysis.
  
  
  RESULTS
  Patients' median age was 30 years and 12 (75%) were nulliparous. Six had a diagnostic cone, 6 had a loop electrocautery excision procedure, 3 had cervical biopsies, and 1 had polyp excision. All patients underwent a preoperative pelvic magnetic resonance imaging. Four patients had stage IA1 with lymph vascular space invasion (LSVI), 6 IA2, and 6 IB1. Ten (62.5%) had squamous lesions, 7 had adenocarcinoma. LVSI was present in 4 cases, suspicious in 2, and absent in 10. There were 2 surgical complications: a trocar site hematoma and a vaginal laceration. The median OR time was 150 minutes (range, 120-180 minutes) and median blood loss was 50 mL (range, 50-150 mL). On final pathology, lymph nodes were negative in all patients. Thirteen (81%) patients had either no residual disease (6) or residual dysplasia only (7) in the trachelectomy specimen. Margins were negative in all cases. With a median follow-up of 27 months (range, 1-65 months), there have been no recurrences. The recurrence-free survival at 24 months is 100%. Eight patients have conceived: 3 were term deliveries and 4 are ongoing.
  
  
  CONCLUSIONS
  Simple trachelectomy and nodes seems to be a safe alternative in well-selected patients with early-stage low-risk cervical cancer. Our data will need to be confirmed in larger series.
authors.affiliation: Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Québec, Canada. marie.plante@crhdq.ulaval.ca
authors.forename: Marie
authors.initials: M
authors.lastname: Plante
authors.forename: Jean
authors.initials: J
authors.lastname: Gregoire
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Renaud
authors.forename: Alexandra
authors.initials: A
authors.lastname: Sebastianelli
authors.forename: Katherine
authors.initials: K
authors.lastname: Grondin
authors.forename: Patricia
authors.initials: P
authors.lastname: Noel
authors.forename: Michel
authors.initials: M
authors.lastname: Roy
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D059247:Fertility Preservation; D005500:Follow-Up Studies; D006801:Humans; D007045:Hysterectomy, Vaginal; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D012196:Review Literature as Topic; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult