Radical trachelectomy with laparoscopic lymphadenectomy: review of oncologic and obstetrical outcomes

Fertility preservation in early cervical cancer by radical trachelectomy is gaining in acceptance as more cases are published in the literature. Controversies regarding technique and patient management are beginning to emerge as the procedure moves from being a new surgery to a part of standard of care.

As the number of cases reported in the literature increases, the effectiveness of radical trachelectomy for treating selected early-stage cancers continues to gain support. The survival of selected patients appears to be no different than that of similar patients treated with radical hysterectomy. Central recurrence in the residual cervix is a very rare event as long as the specimen has cleared the cancer. Patient selection criteria have evolved, and a more liberal use of the procedure is warranted. The effectiveness of trachelectomy in preserving fertility has now been demonstrated in series of 50 and 56 pregnancies occurring after the procedure. These larger series detail pregnancy outcomes and will be invaluable information to our patients who wish to maintain their ability to bear children. Subtle differences in technique between centers may account for different pregnancy outcomes. As more physicians begin to perform radical trachelectomy, controlled trials will be necessary to refine the procedure in order to continue to improve obstetric and oncologic outcomes.

Radical trachelectomy will continue to increase in popularity as more physicians become willing to learn the technique. It should routinely be offered to young women with early cervix cancer who desire to maintain their fertility.