title: Radical trachelectomy in early-stage cervical cancer: A comparison of laparotomy and minimally invasive surgery.
abstract: OBJECTIVE
  Radical trachelectomy is considered standard of care in patients with early-stage cervical cancer interested in future fertility. The goal of this study was to compare operative, oncologic, and fertility outcomes in patients with early-stage cervical cancer undergoing open vs. minimally invasive radical trachelectomy.
  
  
  METHODS
  A retrospective review was performed of patients from four institutions who underwent radical trachelectomy for early-stage cervical cancer from June 2002 to July 2013. Perioperative, oncologic, and fertility outcomes were compared between patients undergoing open vs. minimally invasive surgery.
  
  
  RESULTS
  A total of 100 patients were included in the analysis. Fifty-eight patients underwent open radical trachelectomy and 42 patients underwent minimally invasive surgery (MIS=laparoscopic or robotic). There were no differences in patient age, body mass index, race, histology, lymph vascular space invasion, or stage between the two groups. The median surgical time for MIS was 272min [range, 130-441min] compared with 270min [range, 150-373min] for open surgery (p=0.78). Blood loss was significantly lower for MIS vs. laparotomy (50mL [range, 10-225mL] vs. 300mL [50-1100mL]) (p<0.0001). Nine patients required blood transfusion, all in the open surgery group (p=0.010). Length of hospitalization was shorter for MIS than for laparotomy (1day [1-3 days] vs. 4days [1-9 days]) (p<0.0001). Three intraoperative complications occurred (3%): 1 bladder injury, and 1 fallopian tube injury requiring unilateral salpingectomy in the MIS group and 1 vascular injury in the open surgery group. The median lymph node count was 17 (range, 5-47) for MIS vs. 22 (range, 7-48) for open surgery (p=0.03). There were no differences in the rate of postoperative complications (30% MIS vs. 31% open surgery). Among 83 patients who preserved their fertility (33 MIS vs. 50 open surgery), 34 (41%) patients attempted to get pregnant. Sixteen (47%) patients were able to do so (MIS: 2 vs. laparotomy: 14, p=0.01). The pregnancy rate was higher in the open surgery group when compared to the MIS group (51% vs. 28%, p=0.018). However, median follow-up was shorter is the MIS group compared with the open surgery group (25months [range, 10-69] vs. 66months [range, 11-147]). To date, there has been one recurrence in the laparotomy group and none in the MIS group.
  
  
  CONCLUSIONS
  Our results suggest that radical trachelectomy via MIS results in less blood loss and a shorter hospital stay. Fertility rates appear higher in patients undergoing open radical trachelectomy.
authors.affiliation: Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Marcelo A
authors.initials: MA
authors.lastname: Vieira
authors.affiliation: Department of Gynecologic Oncology, Instituto de Cancerología - Las Américas, Medellín, Colombia.
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Rendón
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Munsell
authors.affiliation: Department of Gynecologic Oncology, Instituto de Cancerología - Las Américas, Medellín, Colombia.
authors.forename: Lina
authors.initials: L
authors.lastname: Echeverri
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Frumovitz
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.affiliation: Department of Gynecologic Oncology, Instituto de Cancerología - Las Américas, Medellín, Colombia.
authors.forename: Rene
authors.initials: R
authors.lastname: Pareja
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Pedro F
authors.initials: PF
authors.lastname: Escobar
authors.affiliation: Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil.
authors.forename: Ricardo Dos
authors.initials: RD
authors.lastname: Reis
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: peramire@mdanderson.org.
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
mesh_terms: D000328:Adult; D005260:Female; D059247:Fertility Preservation; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011247:Pregnancy; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*