Cervical cancer

Area of Science:

• Gynecologic Oncology
• Reproductive Medicine
• Surgical Oncology

Background:

• Standard treatments for invasive cervical cancer (radical surgery or radiotherapy) result in infertility.
• Early-stage cervical tumors may be amenable to less radical, fertility-sparing surgical approaches.
• Radical trachelectomy is a viable fertility-sparing option for select patients with early cervical cancer.

Purpose of the Study:

• To evaluate the efficacy and outcomes of radical vaginal trachelectomy as a fertility-sparing treatment for early invasive cervical cancer.
• To assess the feasibility of conservative surgical management for small cervical tumors.
• To detail the surgical technique and subsequent pregnancy management.

Main Methods:

• Preoperative assessment using magnetic resonance imaging (MRI) for accurate tumor measurement and surgical planning.
• Radical vaginal trachelectomy involving wide excision of the cervix, surrounding tissues, and insertion of an isthmic cerclage.
• Restoration of lower genital tract continuity via vagino-isthmic anastomosis.
• Laparoscopic pelvic-node dissection as part of the surgical approach.

Main Results:

• High fertility rates and low recurrence rates observed in patients undergoing radical trachelectomy.
• Over 1100 procedures performed, resulting in 240 live births.
• Radical vaginal trachelectomy with laparoscopic pelvic-node dissection represents a minimally invasive surgical option.

Conclusions:

• Radical vaginal trachelectomy is an effective fertility-sparing treatment for early, small invasive cervical cancers in carefully selected patients.
• The procedure allows for future childbearing while maintaining low recurrence rates.
• Careful patient selection, precise surgical technique, and meticulous postoperative monitoring are crucial for successful outcomes.