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The security of radical trachelectomy in the treatment of IA–IIA cervical carcinoma requires further evaluation: updated meta-analysis and trial sequential analysis

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Abstract

Purpose

The aim of this study was to assess the security of radical trachelectomy (RT) in the treatment of IA–IIA cervical carcinoma and conducted a new survey based upon the results of previous researches.

Methods

The PMC, PubMed, Web of Science, Cochrane and EMBASE databases were retrieved to collect prospective clinical controlled trials (CCTs) published from 1984 to 2018. The oncologic outcomes were evaluated by meta-analysis, trial sequence analysis (TSA) and statistical analysis.

Results

Five prospective CCTs were collected in this study. The recurrence rate and mortality of RT was similar to that of radical hysterectomy (RH), which was consistent with the oncologic outcomes of meta-analysis and TSA. Patients with tumors 2–4 cm in diameter were more likely to receive RH, which may be a potential factor in the higher rate of adjuvant chemotherapy in the this group, and RH was significantly associated with the risk of intraoperative blood transfusion. It is notable that considerable negative margin was achieved by radical abdominal trachelectomy (RAT), and the clinical effect of RAT was slightly better than that of radical vaginal trachelectomy (RVT). However, the TSA results showed that the cumulative cases were not up to the required sample size to obtain the true negative or positive results.

Conclusions

It is safe and effective for early-stage patients with cervical cancer whose lesions are less than 2 cm to receive RVT. For those patients with lesions 2–4 cm who desire fertility preservation and without any evidence of infertility, RAT can be a feasible alternative to RH under fully informed consent. However, more CCTs with larger sample size are still required for further validation.

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References

  1. Bai H, Yuan F, Wang H, Chen J, Cui Q, Shen K (2015) The potential for less radical surgery in women with stage IA2–IB1 cervical cancer. Int J Gynaecol Obstet 130(3):235–240. https://doi.org/10.1016/j.ijgo.2015.03.042

    Article  PubMed  Google Scholar 

  2. Dargent D, Martin X, Sacchetoni A, Mathevet P (2000) Laparoscopic vaginal radical trachelectomy: a treatment to preserve the fertility of cervical carcinoma patients. Cancer 88(8):1877–1882

    Article  CAS  PubMed  Google Scholar 

  3. Cormier B, Diaz JP, Shih K, Sampson RM, Sonoda Y, Park KJ, Alektiar K, Chi DS, Barakat RR, Abu-Rustum NR (2011) Establishing a sentinel lymph node mapping algorithm for the treatment of early cervical cancer. Gynecol Oncol 122(2):275–280. https://doi.org/10.1016/j.ygyno.2011.04.023

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lecuru F, Mathevet P, Querleu D, Leblanc E, Morice P, Darai E, Marret H, Magaud L, Gillaizeau F, Chatellier G, Dargent D (2011) Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study. J Clin Oncol 29(13):1686–1691. https://doi.org/10.1200/JCO.2010.32.0432

    Article  PubMed  Google Scholar 

  5. Dursun P, Ayhan A, Kuscu E (2008) New surgical approaches for the management of cervical carcinoma. Eur J Surg Oncol 34(5):487–496. https://doi.org/10.1016/j.ejso.2007.07.012

    Article  CAS  PubMed  Google Scholar 

  6. Pahisa J, Alonso I, Torne A (2008) Vaginal approaches to fertility-sparing surgery in invasive cervical cancer. Gynecol Oncol 110(3 Suppl 2):S29–32. https://doi.org/10.1016/j.ygyno.2008.05.005

    Article  PubMed  Google Scholar 

  7. Diaz JP, Sonoda Y, Leitao MM, Zivanovic O, Brown CL, Chi DS, Barakat RR, Abu-Rustum NR (2008) Oncologic outcome of fertility-sparing radical trachelectomy versus radical hysterectomy for stage IB1 cervical carcinoma. Gynecol Oncol 111(2):255–260. https://doi.org/10.1016/j.ygyno.2008.07.014

    Article  PubMed  Google Scholar 

  8. Abu-Rustum NR, Tal MN, DeLair D, Shih K, Sonoda Y (2010) Radical abdominal trachelectomy for stage IB1 cervical cancer at 15-week gestation. Gynecol Oncol 116(1):151–152. https://doi.org/10.1016/j.ygyno.2009.10.042

    Article  PubMed  Google Scholar 

  9. Ramirez PT, Pareja R, Rendon GJ, Millan C, Frumovitz M, Schmeler KM (2014) Management of low-risk early-stage cervical cancer: should conization, simple trachelectomy, or simple hysterectomy replace radical surgery as the new standard of care? Gynecol Oncol 132(1):254–259. https://doi.org/10.1016/j.ygyno.2013.09.004

    Article  PubMed  Google Scholar 

  10. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Cervical Cancer. Version 1.2018 ─ October 25.2017 (2018). National Comprehensive Cancer Network: https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf

  11. Plante M, Renaud MC, Francois H, Roy M (2004) Vaginal radical trachelectomy: an oncologically safe fertility-preserving surgery. An updated series of 72 cases and review of the literature. Gynecol Oncol 94 (3):614–623. https://doi.org/10.1016/j.ygyno.2004.05.032

  12. Beiner ME, Covens A (2007) Surgery insight: radical vaginal trachelectomy as a method of fertility preservation for cervical cancer. Nat Clin Pract Oncol 4(6):353–361. https://doi.org/10.1038/ncponc0822

    Article  PubMed  Google Scholar 

  13. Plante M, Gregoire J, Renaud MC, Roy M (2011) The vaginal radical trachelectomy: an update of a series of 125 cases and 106 pregnancies. Gynecol Oncol 121(2):290–297. https://doi.org/10.1016/j.ygyno.2010.12.345

    Article  PubMed  Google Scholar 

  14. Li J, Wu X, Li X, Ju X (2013) Abdominal radical trachelectomy: Is it safe for IB1 cervical cancer with tumors %3e/= 2 cm? Gynecol Oncol 131(1):87–92. https://doi.org/10.1016/j.ygyno.2013.07.079

    Article  PubMed  Google Scholar 

  15. Xu L, Sun FQ, Wang ZH (2011) Radical trachelectomy versus radical hysterectomy for the treatment of early cervical cancer: a systematic review. Acta Obstet Gynecol Scand 90(11):1200–1209. https://doi.org/10.1111/j.1600-0412.2011.01231.x

    Article  PubMed  Google Scholar 

  16. Beiner ME, Hauspy J, Rosen B, Murphy J, Laframboise S, Nofech-Mozes S, Ismiil N, Rasty G, Khalifa MA, Covens A (2008) Radical vaginal trachelectomy vs. radical hysterectomy for small early stage cervical cancer: a matched case-control study. Gynecol Oncol 110 (2):168–171. https://doi.org/10.1016/j.ygyno.2008.04.027

  17. Marchiole P, Benchaib M, Buenerd A, Lazlo E, Dargent D, Mathevet P (2007) Oncological safety of laparoscopic-assisted vaginal radical trachelectomy (LARVT or Dargent's operation): a comparative study with laparoscopic-assisted vaginal radical hysterectomy (LARVH). Gynecol Oncol 106(1):132–141. https://doi.org/10.1016/j.ygyno.2007.03.009

    Article  PubMed  Google Scholar 

  18. van Gent MD, van den Haak LW, Gaarenstroom KN, Peters AA, van Poelgeest MI, Trimbos JB, de Kroon CD (2014) Nerve-sparing radical abdominal trachelectomy versus nerve-sparing radical hysterectomy in early-stage (FIGO IA2-IB) cervical cancer: a comparative study on feasibility and outcome. Int J Gynecol Cancer 24(4):735–743. https://doi.org/10.1097/IGC.0000000000000114

    Article  PubMed  Google Scholar 

  19. Zhang D, Li J, Ge H, Ju X, Chen X, Tang J, Wu X (2014) Surgical and pathological outcomes of abdominal radical trachelectomy versus hysterectomy for early-stage cervical cancer. Int J Gynecol Cancer 24(7):1312–1318. https://doi.org/10.1097/IGC.0000000000000185

    Article  PubMed  Google Scholar 

  20. Bermudez A, Bhatla N, Leung E (2015) Cancer of the cervix uteri. Int J Gynaecol Obstet 131(Suppl 2):S88–95. https://doi.org/10.1016/j.ijgo.2015.06.004

    Article  PubMed  Google Scholar 

  21. Oncology FCOG (2014) FIGO staging for carcinoma of the vulva, cervix, and corpus uteri. Int J Gynaecol Obstet 125(2):97–98. https://doi.org/10.1016/j.ijgo.2014.02.003

    Article  Google Scholar 

  22. Sedlis ABB, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ (1999) A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy a Gynecologic Oncology Group study. Gynecol Oncol 73(2):177–183

    Article  CAS  PubMed  Google Scholar 

  23. Ramirez PT, Schmeler KM, Soliman PT, Frumovitz M (2008) Fertility preservation in patients with early cervical cancer: radical trachelectomy. Gynecol Oncol 110(3 Suppl 2):S25–28. https://doi.org/10.1016/j.ygyno.2008.03.025

    Article  PubMed  Google Scholar 

  24. Boss EA, van Golde RJ, Beerendonk CC, Massuger LF (2005) Pregnancy after radical trachelectomy: a real option? Gynecol Oncol 99(3 Suppl 1):S152–156. https://doi.org/10.1016/j.ygyno.2005.07.071

    Article  CAS  PubMed  Google Scholar 

  25. Bouchard-Fortier G RC, Covens A (2014) Non-radical surgery for small early-stage cervical cancer. Is it time? Gynecol Oncol 132(3):624–627. https://doi.org/10.1016/j.ygyno.2014.01.037

  26. Kato T, Takashima A, Kasamatsu T, Nakamura K, Mizusawa J, Nakanishi T, Takeshima N, Kamiura S, Onda T, Sumi T, Takano M, Nakai H, Saito T, Fujiwara K, Yokoyama M, Itamochi H, Takehara K, Yokota H, Mizunoe T, Takeda S, Sonoda K, Shiozawa T, Kawabata T, Honma S, Fukuda H, Yaegashi N, Yoshikawa H, Konishi I, Kamura T, Gynecologic Oncology Study Group of the Japan Clinical Oncology G (2015) Clinical tumor diameter and prognosis of patients with FIGO stage IB1 cervical cancer (JCOG0806-A). Gynecol Oncol 137(1):34–39. https://doi.org/10.1016/j.ygyno.2015.01.548

    Article  Google Scholar 

  27. Brok J, Thorlund K, Wetterslev J, Gluud C (2009) Apparently conclusive meta-analyses may be inconclusive—trial sequential analysis adjustment of random error risk due to repetitive testing of accumulating data in apparently conclusive neonatal meta-analyses. Int J Epidemiol 38(1):287–298. https://doi.org/10.1093/ije/dyn188

    Article  PubMed  Google Scholar 

  28. Thorlund K, Devereaux PJ, Wetterslev J, Guyatt G, Ioannidis JP, Thabane L, Gluud LL, Als-Nielsen B, Gluud C (2009) Can trial sequential monitoring boundaries reduce spurious inferences from meta-analyses? Int J Epidemiol 38(1):276–286. https://doi.org/10.1093/ije/dyn179

    Article  PubMed  Google Scholar 

  29. Thorlund K EJ, Wetterslev J, Brok J, Imberger G, Gluud C (2011) User manual for trial sequential analysis (TSA). Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen, Denmark: p. 1–115.Available from www.ctu.dk/tsa

  30. Thorlund K, Anema A, Mills E (2010) Interpreting meta-analysis according to the adequacy of sample size. An example using isoniazid chemoprophylaxis for tuberculosis in purified protein derivative negative HIV-infected individuals. Clin Epidemiol 2:57–66

    PubMed  PubMed Central  Google Scholar 

  31. Brok J, Thorlund K, Gluud C, Wetterslev J (2008) Trial sequential analysis reveals insufficient information size and potentially false positive results in many meta-analyses. J Clin Epidemiol 61(8):763–769. https://doi.org/10.1016/j.jclinepi.2007.10.007

    Article  PubMed  Google Scholar 

  32. Wetterslev J, Thorlund K, Brok J, Gluud C (2008) Trial sequential analysis may establish when firm evidence is reached in cumulative meta-analysis. J Clin Epidemiol 61(1):64–75. https://doi.org/10.1016/j.jclinepi.2007.03.013

    Article  PubMed  Google Scholar 

  33. Ungar L, Palfalvi L, Tarnai L, Horanyi D, Novak Z (2011) Surgical treatment of lymph node metastases in stage IB cervical cancer. The laterally extended parametrectomy (LEP) procedure: experience with a 5 year follow-up. Gynecol Oncol 123(2):337–341. https://doi.org/10.1016/j.ygyno.2011.07.001

  34. Lintner B, Saso S, Tarnai L, Novak Z, Palfalvi L, Del Priore G, Smith JR, Ungar L (2013) Use of abdominal radical trachelectomy to treat cervical cancer greater than 2 cm in diameter. Int J Gynecol Cancer 23(6):1065–1070. https://doi.org/10.1097/IGC.0b013e318295fb41

    Article  PubMed  Google Scholar 

  35. Renaud MC, Plante M, Roy M (2000) Combined laparoscopic and vaginal radical surgery in cervical cancer. Gynecol Oncol 79(1):59–63. https://doi.org/10.1006/gyno.2000.5912

    Article  CAS  PubMed  Google Scholar 

  36. Einstein MH, Park KJ, Sonoda Y, Carter J, Chi DS, Barakat RR, Abu-Rustum NR (2009) Radical vaginal versus abdominal trachelectomy for stage IB1 cervical cancer: a comparison of surgical and pathologic outcomes. Gynecol Oncol 112(1):73–77. https://doi.org/10.1016/j.ygyno.2008.09.007

    Article  PubMed  Google Scholar 

  37. Abu-Rustum NR, Sonoda Y, Black D, Levine DA, Chi DS, Barakat RR (2006) Fertility-sparing radical abdominal trachelectomy for cervical carcinoma: technique and review of the literature. Gynecol Oncol 103(3):807–813. https://doi.org/10.1016/j.ygyno.2006.05.044

    Article  PubMed  Google Scholar 

  38. Plante M (2013) Evolution in fertility-preserving options for early-stage cervical cancer: radical trachelectomy, simple trachelectomy, neoadjuvant chemotherapy. Int J Gynecol Cancer 23(6):982–989. https://doi.org/10.1097/IGC.0b013e318295906b

    Article  PubMed  Google Scholar 

  39. Pareja FR, Ramirez PT, Borrero FM, Angel CG (2008) Abdominal radical trachelectomy for invasive cervical cancer: a case series and literature review. Gynecol Oncol 111(3):555–560. https://doi.org/10.1016/j.ygyno.2008.07.019

    Article  Google Scholar 

  40. Cibula D, Slama J, Svarovsky J, Fischerova D, Freitag P, Zikan M, Pinkavova I, Pavlista D, Dundr P, Hill M (2009) Abdominal radical trachelectomy in fertility-sparing treatment of early-stage cervical cancer. Int J Gynecol Cancer 19(8):1407–1411. https://doi.org/10.1111/IGC.0b013e3181b9549a

    Article  PubMed  Google Scholar 

  41. Karateke A, Kabaca C (2012) Radical abdominal trachelectomy is a safe and fertility preserving option for women with early stage cervical cancer. Eur J Gynaecol Oncol 33(2):200–203

    CAS  PubMed  Google Scholar 

  42. Saso S, Ghaem-Maghami S, Chatterjee J, Naji O, Farthing A, Mason P, McIndoe A, Hird V, Ungar L, Del Priore G, Smith JR (2012) Abdominal radical trachelectomy in West London. BJOG 119(2):187–193. https://doi.org/10.1111/j.1471-0528.2011.03213.x

    Article  CAS  PubMed  Google Scholar 

  43. Wethington SL, Cibula D, Duska LR, Garrett L, Kim CH, Chi DS, Sonoda Y, Abu-Rustum NR (2012) An international series on abdominal radical trachelectomy: 101 patients and 28 pregnancies. Int J Gynecol Cancer 22(7):1251–1257. https://doi.org/10.1097/IGC.0b013e318263eee2

    Article  PubMed  Google Scholar 

  44. Pareja R, Rendon GJ, Sanz-Lomana CM, Monzon O, Ramirez PT (2013) Surgical, oncological, and obstetrical outcomes after abdominal radical trachelectomy—a systematic literature review. Gynecol Oncol 131(1):77–82. https://doi.org/10.1016/j.ygyno.2013.06.010

    Article  PubMed  Google Scholar 

  45. Rob L, Skapa P, Robova H (2011) Fertility-sparing surgery in patients with cervical cancer. Lancet Oncol 12(2):192–200. https://doi.org/10.1016/S1470-2045(10)70084-X

    Article  PubMed  Google Scholar 

  46. Rotman M, Sedlis A, Piedmonte MR, Bundy B, Lentz SS, Muderspach LI, Zaino RJ (2006) A phase III randomized trial of postoperative pelvic irradiation in Stage IB cervical carcinoma with poor prognostic features: follow-up of a gynecologic oncology group study. Int J Radiat Oncol Biol Phys 65(1):169–176. https://doi.org/10.1016/j.ijrobp.2005.10.019

    Article  PubMed  Google Scholar 

  47. Peters WALP, Barrett RJ, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon W Jr, Alberts DS (2000) Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix. J Clin Oncol 18(8):1606–1613

    Article  CAS  PubMed  Google Scholar 

  48. Brydoy M, Fossa SD, Dahl O, Bjoro T (2007) Gonadal dysfunction and fertility problems in cancer survivors. Acta Oncol 46(4):480–489. https://doi.org/10.1080/02841860601166958

    Article  PubMed  Google Scholar 

  49. Gubbala K, Laios A, Gallos I, Pathiraja P, Haldar K, Ind T (2014) Outcomes of ovarian transposition in gynaecological cancers; a systematic review and meta-analysis. J Ovarian Res 7:69. https://doi.org/10.1186/1757-2215-7-69

    Article  PubMed  PubMed Central  Google Scholar 

  50. Salih SM, Albayrak S, Seo S, Stewart SL, Bradley K, Kushner DM (2015) Diminished utilization of in vitro fertilization following ovarian transposition in cervical cancer patients. J Reprod Med 60(7–8):345–353

    PubMed  PubMed Central  Google Scholar 

  51. Hwang JH YH, Park SH, Lim MC, Seo SS, Kang S, Kim JY, Park SY. Association between the location of transposed ovary and ovarian function in patients with uterine cervical cancer treated with (postoperative or primary) pelvic radiotherapy. (1556–5653 (Electronic))

  52. Practice Committees of American Society for Reproductive M, Society for Assisted Reproductive T (2013) Mature oocyte cryopreservation: a guideline. Fertil Steril 99(1):37–43. https://doi.org/10.1016/j.fertnstert.2012.09.028

    Article  Google Scholar 

  53. Practice Committee of American Society for Reproductive M (2014) Ovarian tissue cryopreservation: a committee opinion. Fertil Steril 101(5):1237–1243. https://doi.org/10.1016/j.fertnstert.2014.02.052

    Article  Google Scholar 

  54. Potter R, Kirisits C, Fidarova EF, Dimopoulos JC, Berger D, Tanderup K, Lindegaard JC (2008) Present status and future of high-precision image guided adaptive brachytherapy for cervix carcinoma. Acta Oncol 47(7):1325–1336. https://doi.org/10.1080/02841860802282794

    Article  PubMed  Google Scholar 

  55. Potter R, Haie-Meder C, Van Limbergen E, Barillot I, De Brabandere M, Dimopoulos J, Dumas I, Erickson B, Lang S, Nulens A, Petrow P, Rownd J, Kirisits C, Group GEW (2006) Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol 78(1):67–77. https://doi.org/10.1016/j.radonc.2005.11.014

    Article  Google Scholar 

  56. Reade CJ, Eiriksson LR, Covens A (2013) Surgery for early stage cervical cancer: how radical should it be? Gynecol Oncol 131(1):222–230. https://doi.org/10.1016/j.ygyno.2013.07.078

    Article  PubMed  Google Scholar 

  57. Zhang W, Zhang J, Yang J, Xue H, Cao D, Huang H, Wu M, Cui Q, Chen J, Lang J, Shen K (2014) The role of magnetic resonance imaging in pretreatment evaluation of early-stage cervical cancer. Int J Gynecol Cancer 24(7):1292–1298. https://doi.org/10.1097/igc.0000000000000169

    Article  PubMed  Google Scholar 

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Acknowledgements

This work is supported by the Foreign Cooperation Projects of Chinese Ministry of Science and Technology (No. 2012DFA30490), Beijing Natural Science Foundation (No. 7172077), National High Technology Research and Development Program of China (No. 2014AA020606), and Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding (No. ZYLX201713)

Funding

This study was funded by the Foreign Cooperation Projects of Chinese Ministry of Science and Technology (No. 2012DFA30490), National High Technology Research and Development Program of China (No. 2014AA020606), Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding (No. ZYLX201713), and Beijing Natural Science Foundation (No. 7172077).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8, North Road of Workers Stadium, Chaoyang District, Beijing, 100020, China

    Ying Feng, Tong Lou, Shuzhen Wang, Huimin Bai & Zhenyu Zhang

  2. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China

    Zihan Zhang

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YF: Project development, data collection and management, data analysis, manuscript writing. ZHZ: Data collection and management, data analysis. TL: Data collection and management, data analysis. SZW: Data collection and management, data analysis. HMB: Project development, data collection and management, data analysis, manuscript writing. ZYZ: Project development, data collection and management, data analysis, manuscript writing.

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Correspondence to Huimin Bai or Zhenyu Zhang.

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A similar abstract we wrote was published in the journal of Obstetrics & Gynecology. Author Ying Feng declares that she has no other conflict of interest. Author Zihan Zhang declares that she has no other conflict of interest. Author Tong Lou declares that she has no other conflict of interest. Author Shuzhen Wang declares that she has no other conflict of interest. Author Huimin Bai declares that she has no other conflict of interest. Author Zhenyu Zhang declares that he has no other conflict of interest.

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Feng, Y., Zhang, Z., Lou, T. et al. The security of radical trachelectomy in the treatment of IA–IIA cervical carcinoma requires further evaluation: updated meta-analysis and trial sequential analysis. Arch Gynecol Obstet 299, 1525–1536 (2019). https://doi.org/10.1007/s00404-019-05141-9

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