Abstract
Radical hysterectomy with pelvic node dissection is the standard treatment for early-stage cervical cancer. However, the latter can be diagnosed at a young age when patients have not yet achieved their pregnancy plans. Dargent first described the vaginal radical trachelectomy for patients with tumors <2 cm. It has since been described a population of low risk of recurrence: patients with tumors <2 cm, without deep stromal infiltration, without lymphovascular invasion (LVSI), and with negative lymph nodes. These patients can benefit from a less radical surgery such as conization or simple trachelectomy with the evaluation of the pelvic node status. Tumors larger than 2 cm have a higher risk of recurrence and their treatment is a challenge. There are currently two options for these patients: abdominal radical trachelectomy or neoadjuvant chemotherapy (NACT), followed by fertility-sparing surgery. All patients who wish to preserve their fertility must be referred to expert centers.
Highlights
Introduction and MarieMadeleine DolmansDespite prevention screening campaigns for cervical cancer and the widespread of HPV-vaccination among several countries, this disease remains the fourth most common cancer in women worldwide [1]
Since the survival rates of this procedure are comparable to radical hysterectomy for earlystage cervical cancers, it is one of the standard fertility-sparing treatment
Neoadjuvant Chemotherapy (NACT) Followed by Vaginal Radical Trachelectomy or Abdominal Radical Trachelectomy for Tumors >2 cm Patients with Federation of Gynecology and Obstetrics (FIGO) 2018 stage-IB2 cervical cancer who wish to preserve their fertility have a high risk of relapse
Summary
Despite prevention screening campaigns for cervical cancer and the widespread of HPV-vaccination among several countries, this disease remains the fourth most common cancer in women worldwide [1]. Since the survival rates of this procedure are comparable to radical hysterectomy for earlystage cervical cancers, it is one of the standard fertility-sparing treatment. It is hypothesized that parametrectomy can increase the risk of miscarriage and preterm delivery For all these reasons, less radical treatments have been used for several years for selected patients. Since Dargent’s procedure, others’ approaches of radical tracheclectomy have been described, such as abdominal radical trachelectomy or minimally invasive radical trachelectomy (laparoscopic or robot-assisted). These approaches are thought to be more radical in terms of parametrial resection; they could be proposed to patients with tumors with unfavorable prognosis (tumor size >2 cm, LVSI). It seems reasonable to advise to perform a vaginal radical trachelectomy
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