Initial experience with Dargent's operation: The radical vaginal trachelectomy

Abstract

Objective. To report on our initial experience with radical vaginal trachelectomy for patients with early-stage cervical cancer. Methods. Data on patients undergoing radical vaginal trachelectomy with pelvic lymphadenectomy from 11/01 to 12/06 were collected in a prospective database. Results. Forty-three women with early-stage cervical cancer were operated on with the intent of fertility preservation with radical vaginal trachelectomy. Median age was 31 years (range, 20–40 years). FIGO stage for the group was: IB1, 28; IA2, 7; IA1 with lymphovascular invasion, 8. Histologic type included: squamous, 24; adenocarcinoma, 16; adenosquamous, 3. Parity for the group was: nullipara, 35; one child, 7; two children, 1. Median BMI was 24 kg/m 2 (range, 19–42 kg/m 2). Two patients (5%) underwent completion hysterectomy due to extensive endocervical disease. The median OR time was 330 min (range, 220–480 min). Median pelvic lymph node count was 25 (range, 9–52). Median hospital stay was 3 days (range, 3–7 days). Four patients (9%) required a second intervention for a perioperative complication. Five patients (12%) underwent adjuvant chemoradiation for pathologic risk factors determined on final pathology. Eleven (79%) of 14 women who were trying to get pregnant were able to conceive. Four (36%) required assisted reproductive techniques to conceive. Four patients delivered by cesarean section after 35 weeks and four patients are currently pregnant. With a median follow-up of 21 months in patients treated with trachelectomy alone, we have had one recurrence. Conclusions. Radical vaginal trachelectomy can be incorporated into gynecologic oncology practices and appears to be a reasonable option for patients with early cervical cancer who desire to maintain their fertility. It should be discussed with candidate patients during preoperative consultation.