Radical trachelectomy in early-stage cervical cancer: Is minimally invasive surgery the new standard of care?

Abstract

morbidity. The goal of this study was to evaluate the outcomes of women with early-stage cervical cancer treated with a nonradical surgical approach. Methods: Between March 1991 and July 2013, 51 women with earlystage cervical cancer were treated with simple hysterectomy or cone biopsy and concomitant bilateral pelvic lymphadenectomy or sentinel lymph node biopsy. Data on patient demographics, clinical stage, perioperative complications, pathology findings, and diseasefree interval were collected prospectively. Results: The median age of the woman was 34 years (range, 19– 77 years). Twenty-five women had squamous cell carcinoma (SCC), 22 had adenocarcinoma (AC), and 3 had adenosquamous (AS) carcinoma. Thirty women had FIGO stage 1A1 disease, 8 women had stage IA2 disease, and 13 women had stage 1B1 disease. Twentytwo (43%) and 29 (57%) women underwent simple hysterectomy with lymphadenectomy and cone biopsy with lymphadenectomy, respectively. Median tumor size was 10 mm (range, 2–11 mm). Lymphovascular space invasion (LVSI) was present in 18 women (35%). The median depth of invasion was 2.0 mm (range, 0.6– 12 mm), 2.0 mm (range, 0.1–4.5 mm), and 2.0 mm (range, 1.7– 4.0 mm) for women with SCC, AC, and AS, respectively. The margins were clear in all women. Two women received adjuvant chemoradiation (one had deep stromal invasion on cone biopsy with LVSI and one had two micrometastases to pelvic nodes). More than 95% (49 of 51 women) of patients had their Foley catheter removed on the day of surgery or postoperative day 1. There were no intraoperative or postoperative complications, and the average blood loss was estimated at 143 mL. Median follow-up was 21 months (range, 1– 112 months). None of the 51 women with early-stage cervical cancer developed a recurrence during their follow-up time (95% CI: 0–6%). Conclusions: Nonradical surgery in appropriately selected early-stage cervical cancer patients appears to be associated with a very low perioperative complication rate and excellent oncologic outcomes. While large phase II and III studies are underway, this approach seems to be a safe and reasonable option in well-selected patients.