Clinical effect and fertility outcomes of treatment by vaginal radical trachelectomy to patients with early stages of cervical cancer

Abstract

Objective To study prognosis and fertility outcomes of patients with early stage of cervical cancer treated by vaginal radical trachelectomy (VRT) in combination with laparoscopic pelvic lymphadenectomy. Methods From January 2008 to March 2013, a total of 48 cases of early cervical cancer patients who received VRT in Huangshi Maternal and Child Health Care Hospital were selected as study subjects. Their median age was 29 years. According to the International Federation of Gynecology and Obstetrics (FIGO) stage of cervical cancer, 5 cases of them were in stage of ⅠA1, 4 cases were in stage of ⅠA2, and 39 cases were in stage of ⅠB1. Among them 20 cases' cervical cancer were not visible to the naked eye, 20 cases' diameters of cervical cancer were equal or less than 2 cm, 8 cases were more than 2 cm. Pathological types of cervical cancer in this group, 42 cases were squamous cell carcinoma, and 6 cases were adenocarcinoma or adenocarcinoma. Pelvic node involvement or the cervical internal jugular margin involvement were excluded. By retrospectively method, the surgical data, disease recurrences and fertility outcomes of 48 cases of early cervical cancer patients were statistically analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Huangshi Maternal and Child Health Care Hospital in Hubei Province. Informed consent was obtained from all participants. Results ①Forty-eight patients succeeded in preserving fertility by VRT. The mean duration of VRT was (185±35) min, intraoperative mean blood loss volume was (310±131) mL. The mean excised cervical length and parametrial width was (2.6±0.6) cm and (1.9±0.5) cm, respectively. ② Six recurrences (12%) were observed after following up for a mean duration of (35±21) months. The recurrent rate in patients with tumor diameter>2 cm was significantly higher than that of the patients with tumor diameter ≤2 cm (37.5% vs 8.0%, χ2=12.52, P<0.01) and the difference was significantly different. The recurrent rate in patients with adenocarcinoma or squamous cell carcinoma was significantly higher than that of the patients with cervical squamous cell carcinoma (50% vs 7%, χ2=18. 66, P<0.01) and the difference was significantly different. ③Among the 35 patients who desired to conceive after the surgery, 13 women had 17 pregnancies and the pregnant rate was 37.1% (13/35). Nine women obtained 10 healthy live birth babies. The fertility rate was 25.7% (9/35). Conclusions VRT combined with laparoscopic pelvic lymphadenectomy could preserve the fertility of patients with early stage of cervical cancer with acceptable oncologic and fertility outcomes. Tumor diameter ≤2 cm should be emphasized as the indication of VRT in considering of the higher recurrent rate in patients with tumor diameter >2 cm. Key words: Vaginal radical trachelectomy; Cervical cancer; Fertility preservation