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Excisional cone as fertility-sparing treatment in early-stage cervical cancer
Anna Fagotti1, Maria Lucia Gagliardi, Cristina Moruzzi
1Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy. anna.fagotti@rm.unicatt.it
Objective:
To describe a case series of early-stage cervical cancer patients treated with excisional cone instead of radical trachelectomy as fertility-sparing surgery.
Design:
Prospective study.
Setting:
University hospital.
Patient(S):
Early-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IA2-IB1), age ≤ 45 years, tumor ≤ 20 mm.
Intervention(S):
Cold-knife conization and laparoscopic pelvic lymphadenectomy.
Main Outcome Measure(S):
Recurrence and pregnancy rate.
Result(S):
There were 17 patients: 4 (23.5%) IA2, 13 (76.5%) IB1; 12 (70.5%) squamous cell carcinoma, 4 (23.5%) adenocarcinoma, and 1 (6%) glassy cell tumor. Four cases (23.5%) involved lymphovascular space invasion. The median number of lymph nodes removed was 18 (range 13-51). None of the patients received neoadjuvant chemotherapy, and two patients (12%) received three courses of adjuvant chemotherapy. No recurrences were observed after a median follow-up of 16 months (range 8-101 months). Two of five patients (40%) attempting to conceive had a spontaneous pregnancy and delivery.
Conclusion(S):
In selected and informed patients, conization and laparoscopic pelvic lymphadenectomy seems to be feasible as a fertility-sparing surgical approach.
