Zusammenfassung
Frauen mit Kinderwunsch und einem Zervixtumor von <2 cm Durchmesser, negativen pelvinen und parametranen Lymphknoten, fehlender Kombination aus Befall von Blut- und Lymphgefäßen und Ausschluss einer neuroendokrinen Differenzierung sind Kandidatinnen für die radikale vaginale Trachelektomie. Die onkologische Sicherheit dieser neueren Methode zur Behandlung des Zervixfrühkarzinoms wurde im Rahmen der AGO-Studie „Uterus VI“ evaluiert und erwiesen. Die Rezidivrate beträgt <10%.
Schlüsselwörter
Laparoskopie Trachelektomie AGO-StudiePreservation of fertility in women with early carcinoma of the cervix
Abstract
Women who present with a cervical tumor 2 cm or less in diameter, negative pelvic and parametrial lymph nodes, no combined angio- and lymphangiovascular tumor involvement and no neuroendocrine histology and who wish to preserve their childbearing potential are ideal candidates for radical vaginal cervicectomy. The oncological safety of this surgical method has been evaluated and confirmed in the AGO’s Uterus VI study. The recurrence rate in such patients is under 10%.
Keywords
Laparoscopy Trachelectomy AGO studyNotes
Interessenkonflikt
Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.
Literatur
- 1.Bali A, Weeks A, Van Trappen Pet al. (2005) Central pelvic recurrence 7 years after radical vaginal trachelectomy. Gynecol Oncol 96: 854–856CrossRefPubMedGoogle Scholar
- 2.Boss EA, van Golde RJ, Beerendonk CCet al. (2005) Pregnancy after radical trachelectomy: a real option? Gynecol Oncol. S152–6Google Scholar
- 3.Burnett AF, Roman LD, O‘Meara AT et al. (2003) Radical vaginal trachelectomy and pelvic lymphadenectomy for preservation of fertility in early cervical carcinoma. Gynecol Oncol 88: 419–423CrossRefPubMedGoogle Scholar
- 4.Covens A, Shaw P, Murphy J et al. (1999) Is radical trachelectomy a safe alternative to radical hysterectomy for patients with stage IA-B carcinoma of the cervix? Cancer 86: 2273–2279CrossRefPubMedGoogle Scholar
- 5.Dargent D, Brun JL, Roy M et al. (1994) La trachélectomie élargie (T.E.), une alternative à l’hystérectomie radicale dans le traitement des cancers infiltrants développés sur la face externe du col utérin. Jobgyn 2: 285–292Google Scholar
- 6.Hertel H, Kohler C, Grund D et al. (2006) for the German Association of Gynecologic Oncologists (AGO). Radical vaginal trachelectomy (RVT) combined with laparoscopic pelvic lymphadenectomy: Prospective multicenter study of 100 patients with early cervical cancer. Gynecol Oncol (Epub ahead of print)Google Scholar
- 7.Kolstad P (1989) Follow up study of 232 patients with stage 1a1 and 411 patients with stage 1a2 squamous cell carcinoma of the cervix (microinvasive carcinoma). Gynecol Oncol 33: 265–272CrossRefPubMedGoogle Scholar
- 8.Malur S, Krause N, Köhler C et al. (2001) Sentinel lymph node detection in patients with cervical cancer. Gynecol Oncol. 80: 254–257Google Scholar
- 9.Mathevet P, Laszlo de Kaszon E, Dargent D (2003) Fertility preservation in early cervical cancer. Gynecol Obstet Fertil 31: 706–712CrossRefPubMedGoogle Scholar
- 10.Morice P, Dargent D, Haie-Meder C et al. (2004) First case of a centropelvic recurrence after radical trachelectomy: literature review and implications for the preoperative selection of patients. Gynecol Oncol. 92: 1002–1005Google Scholar
- 11.Newcombe RG (1998) Two-sided confidence intervals for the single proportion: comparison of seven methods. Statistics in Medicine 17: 857–872CrossRefPubMedGoogle Scholar
- 12.Piketty M, Barranger E, Najat M et al. (2005) Ovarian recurrence after radical trachelectomy for adenocarcinoma of the cervix. Am J Obstet Gynecol. 193: 1382–1383Google Scholar
- 13.Plante M, Renaud MC, Francois H et al. (2004) Vaginal radical trachelectomy: an oncologically safe fertility-preserving surgery. An update series of 72 cases and review of the literature. Gynecol Oncol 94: 614–623CrossRefPubMedGoogle Scholar
- 14.Plante M, Renaud MC, Hoskins IA et al. (2005) Vaginal radical trachelectomy: a valuable fertility-preserving option in the management of early-stage cervical cancer. A series of 50 pregnancies and review of the literature. Gynecol Oncol. 98: 3–10Google Scholar
- 15.Schlaerth JB, Spirtos NM, Schlaerth AC (2003) Radical trachelectomy and pelvic lymphadenectomy with uterine preservation in the treatment of cervical cancer. Am J Obstet Gynecol 188: 29–34CrossRefPubMedGoogle Scholar
- 16.Shepherd JH, Crawford RA, Oram DH (2001) Radical trachelectomy in early stage carcinoma of the cervix: outcome as judged by recurrence and fertility rates. BJOG 108: 882–885CrossRefPubMedGoogle Scholar
- 17.Shepherd JH, Spencer C, Herod J et al. (2006) Radical vaginal trachelectomy as a fertility-sparing procedure in women with early-stage cervical cancer-cumulative pregnancy rate in a series of 123 women. BJOG 113: 719–724PubMedGoogle Scholar
- 18.Wilson EB (1927) Probable inference, the law of succession, and statistical interference. J Am Stat Ass 22: 209–212CrossRefGoogle Scholar
- 19.Winter R, Haas J, Reich O et al. (2002) Parametrial spread of cervical cancer in patients with negative pelvic lymph nodes. Gynecol Oncol 84: 525–527Google Scholar