Radical trachelectomy: a way to preserve fertility in the treatment of early cervical cancer
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Abstract:
In the Centenary year of Wertheim's hysterectomy for the treatment of invasive cervical cancer, it is appropriate to look at less radical methods of managing early stage disease. Radical trachelectomy with pelvic lymphadenectomy is a conservative but locally radical procedure, preserving the corpus uteri and therefore fertility potential. The first 10 cases in a pilot study are presented. One patient has required post-operative radiotherapy and another a completion radical hysterectomy. Three live births by caesarean section and three other pregnancies have resulted. Careful selection within strict criteria may allow this more conservative approach without compromising cure. These procedures should be carried out in referral centres with continuing follow up and review.Keywords:
Trachelectomy
Radical surgery
Conservative Treatment
We present the case of a 34-year-old woman, with cervical cancer Stage IB2, treated with radical trachelectomy (and bilateral lymphadenectomy) instead of radical hysterectomy. Recurrence of the disease was diagnosed just a few months after the initial operation. Although the woman's desire was the preservation of fertility, it should be emphasized that best cancer treatment according to stage, is necessary to not endanger the patients’ life.
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Trachelectomy
Radical surgery
Lymphadenectomy
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In the Centenary year of Wertheim's hysterectomy for the treatment of invasive cervical cancer, it is appropriate to look at less radical methods of managing early stage disease. Radical trachelectomy with pelvic lymphadenectomy is a conservative but locally radical procedure, preserving the corpus uteri and therefore fertility potential. The first 10 cases in a pilot study are presented. One patient has required post-operative radiotherapy and another a completion radical hysterectomy. Three live births by caesarean section and three other pregnancies have resulted. Careful selection within strict criteria may allow this more conservative approach without compromising cure. These procedures should be carried out in referral centres with continuing follow up and review.
Trachelectomy
Radical surgery
Conservative Treatment
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Although radical hysterectomy or radical trachelectomy with lymph node assessment are both considered a gold standard treatment for patients with cervical cancer stages IA2 and IB1, radical procedures (parametrectomy) are associated with an increased risk of morbidity and inferior quality of life as well as adverse obstetrical outcomes for radical trachelectomy. Moreover, prior studies demonstrated that in patients with favorable factors, such as: tumor size ≤2 cm, depth of stromal invasion <10 mm, and the absence of lymphovascular space, and negative pelvic nodes the risk of parametrial involvement is below 1%. The mounting evidence from retrospective and prospective studies (ConCerv trial) suggest that in those with a low risk of parametrial involvement simple surgery (conization, trachelectomy or hysterectomy) with lymph node assessment might be a safe alternative to the radical surgery (parametrectomy). It is expected that the results of two large prospective trials: GOG 278 and SHAPE will add to this debate in favor of “simple” surgery with lymph node assessment.
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Radical trachelectomy is a new technique for early cervical cancer,including the resection of cervix and pelvic lymph node.Because the uterus is not removed,reproductive function could be preserved.It has been proved that its efficacy and complications is similar with the radical hysterectomy.And full-term pregnancy can be achieved in some patients.It could not only treat patients minimally invasively but also retain physiological functions.However,the pelvic floor reconstruction is the main problem for it.This article will be concentrate on it.
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Radical hysterectomy has traditionally been the treatment of choice for early invasive cervical carcinoma. Validation of the sentinel lymph node concept in gynaecology has led to less radical surgery. If preservation of fertility is an issue, then radical trachelectomy is an accepted approach.A 29-year-old female presented with stage IB1 cervical cancer was treated by radical vaginal trachelectomy and pelvic lymphadenectomy as definitive treatment. Two obturator nodes visualised on lymphoscintigraphy and one parametrial not visualized on lymphoscintigraphy were "hot" and blue during surgery, and identified as sentinel nodes. All 18 nodes were non-metastatic.Preoperative lymphoscintigraphy is a useful tool in the preoperative localisation of sentinel lymph nodes, and should be undertaken in cases of early invasive cervical carcinoma where a radical trachelectomy is performed to preserve fertility.
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Background: The impairment of spontaneous voiding is the most prominent type of morbidity in the early postoperative period after radical hysterectomy. The aim of our work was to evaluate the parameters affecting the recovery of spontaneous voiding. Methods: Enrolled were women in whom radical procedure for early-stage cervical cancer was performed in the period from 2006 to 2008. Satisfactory spontaneous voiding was characterized by the reduction of postvoiding urine residuum to 50 mL or less in the course of a whole day. Results: Data from 85 patients were evaluated retrospectively (radical hysterectomy 67, radical parametrectomy 6, and radical trachelectomy 12), of which 35 underwent nerve-sparing modification, 19 underwent type C radicality of procedure, and 31 underwent type D radicality of procedure. Radicality of parametrectomy was the most significant parameter influencing the interval to spontaneous voiding recovery ( P < 0.05); significant differences were observed between nerve-sparing and type D procedures. Multivariate analysis revealed 3 significant parameters: procedure radicality ( P < 0.001), type of procedure (radical hysterectomy vs radical trachelectomy; P < 0.05), and a negative correlation with body mass index ( P < 0.05). Long-term spontaneous voiding impairment lasting more than 6 weeks was observed in 7 patients, of whom 5 had undergone type D procedure. Conclusions: The radicality of parametrial resection is the most prominent factor determining the interval to spontaneous voiding, with significantly poorer outcomes after type D procedure. Interestingly, another significant parameter in our study was the type of parametrectomy, with better outcomes achieved after radical trachelectomy. Delayed voiding recovery was observed in patients with lower body mass index.
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In recent years a new less radical methods in the treatment of early cervical carcinoma has been introduced. The radical trachelectomy with laparoscopic pelvic lymphadenectomy represents one of these options. This procedure is special in that it not only treats the cervical cancer in acceptable oncological fashion but at the same time preserves the fertility potential of the patients. Thus, this surgery represents a midway point in between conisation and radical hysterectomy. Based on our initial experience in this study the technique of radical trachelectomy is analysed in detail and at the same time the current literature on the subject is reviewed. We conclude that after careful selection of the patients this more conservative approach leads to the same results comparable to classical radical surgery.
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The management of early stage cervical cancer often includes surgery in the form of radical hysterectomy, radical trachelectomy, or radical parametrectomy. Surgical techniques have evolved to include minimal invasive approaches, and more recently, to include robotic assisted techniques. This review highlights the evolution of surgical management of early cervical cancer and specifically explores robotic assisted radical hysterectomy, radical trachelectomy, radical parametrectomy, and the role of neoadjuvant chemotherapy. J. Surg. Oncol. 2015;112:772–781 . © 2015 Wiley Periodicals, Inc.
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Objective Treatment of invasive cervical cancer is affected by the stage of the disease, which is based on clinical evaluation. Method Reviewing later articles related therapic strategy of cervical cancer. Result Microinvasive carcinoma of the cervix has limited metastatic potential and therefore is most likely curable by non-radical treatment. Both radical surgery and radical radiotherapy have been proven to be effective equally, but differ in associated complications. In common, stage Ib1 cervical cancer is treated by radical hysterectomy with pelvic lymphadenectomy. Comparing with the modality, Laparoscopically assisted radical vaginal hysterectomy has shown similar efficacy and recurrence rates. In small cervical cancer where preservation of fertility is desired,radical vaginal trachelectomy with laparoscopic pelvic lymphadenectomy may be an option. Neoadjuvant chemotherapy followed by radical surgery may improve a survival in patients with stage Ib cervical carcinoma. Concomitant chemo-radiation is becoming a new standard in treatment of advanced disease, because it has been clearly shown to improve disease-free, progression-free and overall survival. Conclutions Treatment decisions should be individualized and based on multiple factors including the stage of the disease, age, medical condition of the patient, tumor-related factors and treatment preferences, to yield the best cure with minimum complications.
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