Surgical and pathologic outcomes of fertility-sparing radical abdominal trachelectomy for FIGO stage IB1 cervical cancer Journal Article
| Authors: | Abu-Rustum, N. R.; Neubauer, N.; Sonoda, Y.; Park, K. J.; Gemignani, M.; Alektiar, K. M.; Tew, W.; Leitao, M. M.; Chi, D. S.; Barakat, R. R. |
| Article Title: | Surgical and pathologic outcomes of fertility-sparing radical abdominal trachelectomy for FIGO stage IB1 cervical cancer |
| Abstract: | Objectives: To describe the surgical and pathologic findings of fertility-sparing radical abdominal trachelectomy using a standardized surgical technique, and report the rate of post-trachelectomy adjuvant therapy that results in permanent sterility. Methods: A prospectively maintained database of all patients with FIGO stage IB1 cervical cancer admitted to the operating room for planned fertility-sparing radical abdominal trachelectomy was analyzed. Sentinel node mapping was performed via cervical injection of Technetium and blue dye. Results: Between 6/2005 and 5/2008, 22 consecutive patients with FIGO stage IB1 cervical cancer underwent laparotomy for planned fertility-sparing radical abdominal trachelectomy. Median age was 33 years (range, 23-43). Histology included 13 (59%) with adenocarcinoma and 9 (41%) with squamous carcinoma. Lymph-vascular invasion was seen in 9 (41%) cases. Only 3 (14%) needed immediate completion radical hysterectomy due to intraoperative findings (2 for positive nodes, 1 for positive endocervical margin). Median number of nodes evaluated was 23 (range, 11-44); and 6 (27%) patients had positive pelvic nodes on final pathology - all received postoperative chemoradiation. Sixteen (73%) patients agreed to participate in sentinel node mapping which yielded a detection rate of 100%, sensitivity of 83%, specificity of 100% and false-negative rate of 17%. Eighteen of 19 (95%) patients who completed trachelectomy had a cerclage placed, and 9/22 (41%) patients had no residual cervical carcinoma on final pathology. Median time in the operating room was 298 min (range, 180-425). Median estimated blood loss was 250 ml (range, 50-700), and median hospital stay was 4 days (range, 3-6). No recurrences were noted at the time of this report. Conclusions: Cervical adenocarcinoma and lymph-vascular invasion are common features of patients selected for radical abdominal trachelectomy. The majority of patients can undergo the operation successfully; however, nearly 32% of all selected cases will require hysterectomy or postoperative chemoradiation for oncologic reasons. Sentinel node mapping is useful but until lower false-negative rates are achieved total lymphadenectomy remains the gold standard. Investigating alternative fertility-sparing adjuvant therapy in node positive patients is needed. © 2008 Elsevier Inc. All rights reserved. |
| Keywords: | adult; clinical article; controlled study; treatment outcome; young adult; squamous cell carcinoma; carcinoma, squamous cell; adjuvant therapy; cancer staging; lymphatic metastasis; neoplasm staging; laparotomy; sentinel lymph node; adenocarcinoma; lymphedema; hospitalization; uterine cervix cancer; stenosis; gynecologic surgical procedures; abdominal trachelectomy; fertility; uterine cervical neoplasms; gynecologic surgery; operating room; radical hysterectomy; cervical cancer; fertility-sparing surgery; sentinel node mapping; amenorrhea; technetium; cervicectomy; female sterility; uterine cervix cerclage |
| Journal Title: | Gynecologic Oncology |
| Volume: | 111 |
| Issue: | 2 |
| ISSN: | 0090-8258 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2008-11-01 |
| Start Page: | 261 |
| End Page: | 264 |
| Language: | English |
| DOI: | 10.1016/j.ygyno.2008.07.002 |
| PUBMED: | 18708244 |
| PROVIDER: | scopus |
| PMCID: | PMC4994885 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 24" - "Export Date: 17 November 2011" - "CODEN: GYNOA" - "Source: Scopus" |
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