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Reproductive and oncologic outcome following robot-assisted laparoscopic radical trachelectomy for early stage
Gry Johansen1, Celine Lönnerfors2, Henrik Falconer1
1Department of Obstetrics and Gynecology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Objective:
To investigate the reproductive and oncologic outcome following robotic radical trachelectomy for early stage cervical cancer.
Methods:
All women with early stage cervical cancer planned for fertility-sparing robotic trachelectomy between December 2007 and April 2015 at two tertiary referral centers in Sweden were identified. Perioperative- and follow-up data was retrieved from prospective databases used for all robotic procedures at the respective institution and an additional review of computerized patient files was performed. Reproductive outcome evaluation was restricted to women with ≥12months follow-up and an active wish to conceive. Oncological outcome was evaluated for all patients.
Results:
Fifty-six women (3 stage IA1, 14 stage IA2 and 39 stage IB1) were included. The median age was 29years (range 23-41). Median follow-up was 24months (range 1-89). Seven trachelectomies were aborted in favor of a radical hysterectomy and/or chemoradiation due to nodal metastases or insufficient margins; two distant recurrences occurred in these women. A local recurrence was seen in two of the 49 women (4%) in whom the procedure was completed as planned. Seventeen of the 21 women (81%) in the reproductive follow-up group conceived - 16 naturally and one following IVF. Sixteen women (94%) delivered in the third trimester, 12 women (71%) in gestational week ≥36. One (6%) second trimester delivery occurred.
Conclusion:
The high fertility rate, low rate of premature deliveries and an acceptable rate of recurrence support the feasibility of robotic fertility-sparing radical trachelectomy in women with early stage cervical cancer.
