title: Laparoscopic radical trachelectomy is an alternative to laparotomy with improved perioperative outcomes in patients with early-stage cervical cancer.
abstract: OBJECTIVE
  Radical trachelectomy is an established surgical approach for managing young women with cervical cancer wishing to preserve fertility. The aim of this study was to compare perioperative outcomes between laparoscopic (LRT) and abdominal radical trachelectomy (ART).
  
  
  METHODS
  We reviewed the records of all women undergoing either LRT or ART in our institution since 2004. Demographic data, clinicopathologic data, and perioperative outcomes were collected and compared between the 2 procedures.
  
  
  RESULTS
  Overall, 27 women were identified. All of them had stage IB1 disease. Eleven (40.8%) women underwent LRT, whereas 16 (59.2%) women underwent ART. Age, parity, and body mass index, as well as histologic type, grade, and presence of lymphovascular space invasion were comparable between groups. The median length of the parametrial tissue removed was shorter in LRT versus ART (P = 0.022). The median blood loss and length of stay were significantly reduced in the LRT group (85 vs 800 mL, P < 0.001; and 4 versus 7 days, P = 0.003). The median operative time was longer with the laparoscopic approach (320 versus 192.5 minutes, P < 0.001). Early grade 1 to 2 postoperative morbidity (mainly high urinary residuals) was comparable between groups; however, more grade 3 and late morbidity events were recorded in the ART group.
  
  
  CONCLUSIONS
  This first comparison study between LRT and ART for fertility preservation in women with cervical cancer shows that laparoscopy performed better in terms of blood loss and length of stay. Laparoscopic radical trachelectomy could be the preferred option for these patients; however, further studies are needed to confirm comparable survival outcomes.
authors.affiliation: *Northern Gynaecological Oncology Centre, and †Department of Pathology, Gateshead NHS Trust, Queen Elizabeth Hospital, United Kingdom.
authors.forename: Ali
authors.initials: A
authors.lastname: Kucukmetin
authors.forename: Ioannis
authors.initials: I
authors.lastname: Biliatis
authors.forename: Nithya
authors.initials: N
authors.lastname: Ratnavelu
authors.forename: Amit
authors.initials: A
authors.lastname: Patel
authors.forename: Iain
authors.initials: I
authors.lastname: Cameron
authors.forename: Angela
authors.initials: A
authors.lastname: Ralte
authors.forename: Raj
authors.initials: R
authors.lastname: Naik
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D005298:Fertility; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D059035:Perioperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D055815:Young Adult