Nerve-Sparing Radical Abdominal Trachelectomy Versus Nerve-Sparing Radical Hysterectomy in Early-Stage (FIGO IA2-IB) Cervical Cancer: A Comparative Study on Feasibility and Outcome

• Published in: International journal of gynecological cancer Vol. 24; no. 4; pp. 735 - 743
• Main Authors: van Gent, Mignon Dingena Johanna Maria, van den Haak, Lukas Wesley, Gaarenstroom, Katja Nicolien, Peters, Alexander A W, van Poelgeest, Mariette Inie Elisabeth, Trimbos, Johanes Baptist Maria Zacharias, de Kroon, Cor Doede
• Format: Journal Article
• Language: English
• Published: England by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology 01.05.2014; BMJ Publishing Group LTD
• Subjects: Abdomen; Abdomen - pathology; Abdomen - surgery; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Carcinoma, Adenosquamous - pathology; Carcinoma, Adenosquamous - surgery; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Case-Control Studies; Cervical cancer; Cervix Uteri - pathology; Cervix Uteri - surgery; Feasibility Studies; Female; Fertility; Fertility Preservation; Follow-Up Studies; Gynecologic Surgical Procedures - methods; Humans; Hysterectomy; Middle Aged; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Nervous System; Organ Sparing Treatments - methods; Pregnancy; Prognosis; Prospective Studies; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; Vagina; Womens health; Young Adult
• ISSN: 1048-891X; 1525-1438
• DOI: 10.1097/IGC.0000000000000114

OBJECTIVESStandard treatment in early-stage cervical cancer is a radical hysterectomy (RH) with pelvic lymphadenectomy. In women who wish to preserve fertility radical vaginal trachelectomy has been proposed; however, this is not feasible in larger tumors, and nerve-sparing surgery is not possible. Nerve-sparing radical abdominal trachelectomy (NSRAT) overcomes these disadvantages. METHODSCase-control study of women with early-stage cervical cancer (International Federation of Gynecology and Obstetrics IA2-IB) submitted to NSRAT from 2000 until 2011. Women submitted to nerve-sparing RH with early-stage cervical cancer were included as control subjects. RESULTSTwenty-eight patients and 77 control subjects were included. Neoadjuvant chemotherapy was administered in 3 women before NSRAT because the linear extension was or exceeded 40 mm. Local recurrence rate was 3.6% (95% confidence interval [CI], 0.00–10.6) in the NSRAT group compared with 7.8% (95% CI, 1.7–13.9) in the control group (P = 0.44). No significant difference was found between both groups regarding disease-free survival and survival. The overall pregnancy rate was 52.9% (95% CI, 28.7%–77.2%). The mean follow-up was 47.3 months (range, 6–122 months) for NSRAT and 51.8 months (11–129.6 months) for nerve-sparing RH. CONCLUSIONSNerve-sparing radical abdominal trachelectomy seems safe and effective in women with early-stage cervical cancer who wish to preserve fertility. Respective women should be informed about this treatment option, especially if the tumor is too large for radical vaginal trachelectomy.