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Published on: January 22, 2022
Fertility-sparing surgery for early cervical cancer-approach to less radical surgery
Shanti Kankipati Raju1, Andreas John Papadopoulos, Stephen Attard Montalto
1Department of Gynaecological Oncology, St Thomas' Hospital, London, UK.
Objective:
To evaluate whether certain patients with early-stage cervical cancer are candidates for less radical surgery when considering fertility-sparing surgery.
Design:
Prospective cohort study.
Setting:
Two gynecologic cancer centers (St Thomas' Hospital, London; and West Kent Gynaecological Cancer Centre, Maidstone).
Population:
Women with early-stage cervical cancer (n = 66) undergoing fertility-sparing surgery, either simple (SVT) or radical vaginal trachelectomy (RVT).
Methods:
Prospective clinical data collection and review of patient notes, pathology and radiology data, and pregnancy outcomes.
Main Outcome Measures:
Postoperative complications, surgical specimen histologic analysis, follow-up data, and obstetric outcome.
Results:
A total of 66 women underwent either SVT (n = 15) or RVT (n = 51), with pelvic lymphadenectomy, for stage IA2 or IB1 cervical cancer. There was no residual disease in the SVT specimen in 53% versus 29% after RVT. Clear surgical margins in 100% of SVT specimens with residual disease versus 94% after RVT. Two patients had positive lymph nodes after RVT; one of these declined adjuvant treatment until after egg harvesting and subsequently died of disease (1.5%). Median follow-up was 96 months (range, 12-120 months). One patient had a mid vaginal recurrence (1.5%). Twenty-four women have tried to conceive to date, with 14 women having 17 live births. Live birth pregnancy rate was 70.8%.
Conclusions:
It is possible to select patients for a less radical fertility-sparing procedure through identification of measurable low-risk factors and thus reduce the morbidity caused by conventional RVT. The selection criteria should be stringent and applied within the setting of a cancer center.
