A study of safe criteria for radical trachelectomy in cervical cancer patients to prevent recurrence and catastrophic consequences: A multicenter study
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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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In recent years,the incidence of cervical cancer has the trend to ascend,with the age of patients getting younger.The young patients with cervical cancer need to preserve their fertility sparing.With the development of the new surgery and Laparoscopic,radical trachelectomy surgery,radical trachelectomy surgery as a new method of the treatment of early cervical cancer,restrictedly controls its surgical indications,and in combination with medical ethics and principles of evidence-based medicine,radical trachelectomy surgery not only achieves a radical cure of cervical cancer,but also fully takes into consideration the fertility sparing of the young patients with cervical cancer.Therefore,cervical radical trachelectomy is a feasible,effective and reasonable surgery.
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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.
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The popularization of cervical cytological test significantly reduced the incidence of cervical cancer.However,cervical cancer is still the leading cause of death of the global gynecological cancer patients and the age of the patients is getting younger and younger.The young patients with early-stage cervical cancer can be treated with radical trachelectomy and bilateral pelvic lymph node dissection by vaginal,abdominal or laparoscopic methods,to preserve their fertility,which has been reported at home and abroad.By reviewing the related literature,this article gives us a brief summary of the indications,surgical progress and the pregnancy after the radical surgery of cervix.
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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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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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