[Radical vaginal trachelectomy for invasive cervical cancer]

The use of operative laparoscopy in gynecologic oncology has paved the way to a more conservative approach in radical treatments of some cancers, particularly cervical cancer. After the vaginal approach which shortens the hospital stay and the morbidity of a radical hysterectomy, a new fertility-preserving radical treatment has been proposed : the Radical Vaginal Trachelectomy (RVT). This technique has been used since 1991 in our institution. Until July 1999, 37 patients with early-stage cervical cancer desiring to retain their fertility were treated by a laparoscopic pelvic lymphadenectomy (LPL) and RVT. The median age was 32 (22-42), and 25 were nulliparous. Twelve were FIGO stage Ia2, 22 Ib1, 2 IIa and one Ia1 (VSI+). Most of the tumors were squamous (23), grade I (21), and the lesion was 2cms or less in 35 patients. Median operating time was 275 minutes ( 200 for the last 10 cases), and blood loss 200cc. Complications were mainly due to the LPL (3 arterial injuries) rather than the RVT (one iatrogenic cystotomy and one parametrial bleeding). The mean follow-up is 42 months. Two patients recurred including one who had a small-cell neuroendocrine tumor. Ten patients had a total of 13 pregnancies with 7 live births. One newborn died of E.coli-septicemia. Two patients had early miscarriages and 2 second trimester abortions (17 and 20 weeks). Two patients are still pregnant. LPL-RVT seems to be a good treatment modality for early-stage cervical cancer. It preserves fertility without lowering the chances of survival.