294. Abdominal radical trachelectomy as a fertility-sparing treatment for early-stage cervical cancer; a single institution experience

Abstract

Introduction and aims of the study: The recommended surgical treatment for FIGO stage IA2–IB1 cervical cancer is radical hysterectomy with bilateral pelvic lymphadenectomy. Unfortunately, this procedure leads to loss of fertility. Abdominal Radical Trachelectomy (ART) is a procedure that preserves the uterus without increasing the risk of recurrence while retaining childbearing potential. We describe the surgical, oncologic, and fertility outcomes of patients treated with ART. Methods: We conducted a retrospective analysis of patients undergoing fertility-sparing ART with pelvic lymphadenectomy for early-stage cervical cancer at our institution from 2002 to 2016. Results: A total of 80 patients who underwent ART with pelvic lymphadenectomy were followed for 2–106 months. Thirty-two patients had undergone conization before surgery. The characteristics of the patients included tumor diameter of 8–32 mm (stage IA2 = 10, stage IB1 [b3.2 cm] = 70), average age of 29.5 years (range, 26–43 years), mean operative time of 185 min (range, 142–245 min), and average blood loss of 350 mL (range, 150– 750 mL). Uterine arteries were identified at their origin from the internal iliac artery and gently preserved in 76 cases. There were two recurrences in the paraaortic area treated with chemoradiation (n = 1) and radical hysterectomy (n = 1). Three patients developed high-grade squamous intraepithelial lesions and were successfully treated by loop excision. Forty-five women attempted to conceive, and 34 successful pregnancies were recorded (75%). All of the pregnancies resulted in live births, with a preterm delivery rate of 17.6% (6/34). Conclusions: Our study is one of the largest series of ART to date. Our results show that radical abdominal trachelectomy is feasible and can be performed safely in well-selected patients with cervical cancer who wish to preserve their fertility.