Advertisement

Radical Trachelectomy for Early Stage Cervical Cancer

  • Anthony CostalesEmail author
  • Chad Michener
  • Pedro F. Escobar-Rodriguez
Gynecologic Cancers (LA Cantrell, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Gynecologic Cancers

Opinion Statement

In patients with early-stage cervical cancer, radical hysterectomy and pelvic lymphadenectomy is the gold standard. However, this disease commonly affects women of childbearing age; thus an option to spare fertility is ideal. This option came to fruition in the early 90s when the Dargent procedure or radical trachelectomy was first reported. The procedure has subsequently been modified as technology has improved and now may be performed via minimally invasive techniques. Additionally, with the advent of the sentinel lymph node procedure, the morbidity in this usually young patient population has continued to improve. There is a multitude of data to show that oncologic outcomes, concerning recurrence and mortality, are comparable to radical hysterectomy, as well as obstetrical outcomes are favorable. Data to support its acceptance within the gynecologic oncology community has led to radical trachelectomy being implemented into governing body guidelines and should be offered to appropriate candidates with early-stage cervical cancer who wish to preserve fertility.

Keywords

Early stage cervical cancer Radical trachelectomy Fertility sparing 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommending Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    American Cancer Society. Cancer Facts & Figs. 2018. Atlanta, Ga: American Cancer Society; 2018. https://www.cancer.org/cancer/cervical-cancer/about/key-statistics.html#references. Accessed 15 July 2018
  2. 2.
    SEER Cancer Stat Facts: Cervical Cancer. National Cancer Institute. Bethesda, MD. https://seer.cancer.gov/statfacts/html/cervix.html. Accessed 15 July 2018
  3. 3.
    Rob L, Skapa P, Robova H. Fertility-sparing surgery in patients with cervical cancer. Lancet Oncol. 2011;12:192–200.PubMedGoogle Scholar
  4. 4.
    Sonoda Y, Abu-Rustum NR, Gemignani ML, Chi DS, Brown CL, Poynor EA, et al. A fertility-sparing alternative to radical hysterectomy: how many patients may be eligible? Gynecol Oncol. 2004;95(3):534–8.PubMedGoogle Scholar
  5. 5.
    Bhosale PR, Iyer RB, Ramalingam P, Schmeler KM, Wei W, Bassett RL, et al. Is MRI helpful in assessing the distance of the tumor from the internal os in patients with cervical cancer below FIGO Stage IB2? Clin Radiol. 2016;71(6):515–22.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Roy M, Plante M. Radical vaginal trachelectomy. In: Querleu D, Dargent D, Childers JM, editors. Laparoscopic Surgery in Gynecological Oncology. London: Blackwell Science; 1999. p. 78–82.Google Scholar
  7. 7.
    Smith JR, Boyle DC, Corless DJ, Ungar L, Lawson AD, Del Priore G, et al. Abdominal radical trachelectomy: a new surgical technique for the conservative management of cervical carcinoma. Br J Obstet Gynaecol. 1997;104(10):1196.PubMedGoogle Scholar
  8. 8.
    Abu-Rustum NR, Sonoda Y, Black D, Levine DA, Chi DS, Barakat RR. Fertility-sparing radical abdominal trachelectomy for cervical carcinoma: technique and review of the literature. Gynecol Oncol. 2006;103(3):807–13.PubMedGoogle Scholar
  9. 9.
    Obermair A, Gebski V, Frumovitz M, Soliman PT, Schmeler KM, Levenback C, et al. A phase III randomized clinical trial comparing laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy in patients with early stage cervical cancer. J Minim Invasive Gynecol. 2008;15(5):584–8.PubMedGoogle Scholar
  10. 10.
    Zhang D, Ge H, Li J, Wu X. A new method of surgical margin assuring for abdominal radical trachelectomy in frozen section. Eur J Cancer. 2015;51(6):734–41.PubMedGoogle Scholar
  11. 11.
    Park KJ, Soslow RA, Sonoda Y, Barakat RR, Abu-Rustum NR. Frozen-section evaluation of cervical adenocarcinoma at time of radical trachelectomy: pathologic pitfalls and the application of an objective scoring system. Gynecol Oncol. 2008;110(3):316–23.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Ismiil N, Ghorab Z, Covens A, Nofech-Mozes S, Saad RE, Dube V, et al. Intraoperative margin assessment of the radical trachelectomy specimen. Gynecol Oncol. 2009;113(1):42–6.Google Scholar
  13. 13.
    Tanguay C, Plante M, Renaud MC, Roy M, Tetu B. Vaginal radical trachelectomy in the treatment of cervical cancer: the role of frozen section. Int J Gynecol Pathol. 2004;23(2):170–5.PubMedGoogle Scholar
  14. 14.
    Zigras T, Lennox G, Willows K, Covens A. Early cervical cancer: current dilemmas of staging and surgery. Curr Oncol Rep. 2017;19(8):51.PubMedGoogle Scholar
  15. 15.
    Lecuru F, Mathevet P, Querleu D, Leblanc E, Morice P, Darai E, et al. Bilateral negative sentinel lymph nodes accurately predict absence of lymph node metastases in early cervical cancer: results of the SENTICOL study. J Clin Oncol. 2011;29(13):1686–91.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Bats AS, Buenerd A, Querleu D, Leblanc E, Darai E, Morice P, et al. Diagnostic value of intraoperative examination of sentinel lymph node in early cervical cancer: a prospective, multicenter study. Gynecol Oncol. 2011;123(2):230–5.PubMedGoogle Scholar
  17. 17.
    National Comprehensive Cancer Network. Cervical Cancer (Version 1.2018). http://www.nccn.org/professionals/physician_gls/pdf/cervix.pdf. Accessed 17 Apr 2018.
  18. 18.
    Ungar L, Palfalvi L, Hogg R, Siklos P, Bpyle DCM, del Priore G, et al. Abdominal radical trachelectomy: a fertility-preserving option for women with early cervical cancer. Br J Obstet Gynaecol. 2005;112:366–9.Google Scholar
  19. 19.
    Kim M, Ishioka S, Endo T, Baba T, Akashi Y, Morishita M, et al. Importance of uterine cervical cerclage to maintain a successful pregnancy for patients who undergo vaginal radical trachelectomy. Int J Clin Oncol. 2014;19(5):906–11.PubMedGoogle Scholar
  20. 20.
    • Li X, Li J, Wu X. Incidence, risk factors, and treatment of cervical stenosis after radical trachelectomy. Eur J Cancer. 2015;51(13):1751–9. A systematic review of cervical stenosis following radical trachelectomy. Google Scholar
  21. 21.
    Israfil-Bayli F, Toozs-Hobson P, Lees C, Slack M, Ismail KMK. Pregnancy outcome after elective cervical cerclage in relation to type of suture material used. Med Hypotheses. 2013;81(1):119–21.PubMedGoogle Scholar
  22. 22.
    Tang J, Li J, Wang S, Zhang D, Wu X. On what scale does it benefit the patients if uterine arteries were preserved during ART? Gynecol Oncol. 2014;134(1):154–9.PubMedGoogle Scholar
  23. 23.
    • Escobar PF, Ramirez PT, Garcia Ocasio RE, Pareja R, Zimberg S, Sprague M, et al. Utility of indocyanine green (ICG) intra-operative angiography to determine uterine vascular perfusion at the time of radical trachelectomy. Gynecol Oncol. 2016;143(2):357–61. First evaluation of ICG fluorescence angiography in patients undergoing radical trachelectomy to evaluate uterine perfusion. Based on our real-time intraoperative angiography observations, there is no need to preserve the uterine artery during radical trachelectomy to maintain uterine viability.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Guo J, Zhang Y, Chen X, Sun L, Chen K, Sheng X. Surgical and oncologic outcomes of radical abdominal trachelectomy versus hysterectomy for stage IA2-IB1 cervical cancer. J Minim Invasive Gynecol.Google Scholar
  25. 25.
    Alexander-Sefre F, Chee N, Spencer C, Menon U, Shepherd JH. Surgical morbidity associated with radical trachelectomy and radical hysterectomy. Gynecol Oncol. 2006;101(3):450.PubMedGoogle Scholar
  26. 26.
    Xu L, Sun FQ, Wang ZH. Radical trachelectomy versus radical hysterectomy for the treatment of early cervical cancer: a systematic review. Acta Obstet Gynecol Scand. 2011;90(11):1200–9.PubMedGoogle Scholar
  27. 27.
    Nick AM, Frumovitz MM, Soliman PT, Schmeler KM, Ramirez PT. Fertility sparing surgery for treatment of early-stage cervical cancer: open vs robotic radical trachelectomy. Gynecol Oncol. 2012;124:276–80.PubMedGoogle Scholar
  28. 28.
    •• Vieira MA, Rendon GJ, Munsell M, Echeverri L, Frumovitz M, Schmeler KM, et al. Radical trachelectomy in early-stage cervical cancer: A comparison of laparotomy and minimally invasive surgery. Gynecol Oncol. 2015;138(3):585–9. This is the largest comparative series of open vs. MIS of radical trachelectomy.PubMedGoogle Scholar
  29. 29.
    Boss EA, van Golde RJ, Beerendonk CC, Massuger LF. Pregnancy after radical trachelectomy: a real option? Gynecol Oncol. 2005;99(3 Suppl 1):S152.PubMedGoogle Scholar
  30. 30.
    Pareja R, Rendon GJ, Sanz-Lomana CM, Monzon O, Ramirez PT. Surgical, oncological, and obstetrical outcomes after abdominal radical trachelectomy- a systematic literature review. Gynecol Oncol. 2013;131(1):77–82.PubMedGoogle Scholar
  31. 31.
    Morice P, Dargent D, Haie-Meder C, Duvillard P, Castaigne D. First case of a centropelvic recurrence after radical trachelectomy: literature review and implications for the preoperative selection of patients. Gynecol Oncol. 2004;92(3):1002–5.PubMedGoogle Scholar
  32. 32.
    Del Priore G, Ungar L, Richard Smith J, Heller PB. Regarding “First case of a centropelvic recurrence after radical trachelectomy: literature review and implications for the preoperative selection of patients,” (92:1002–5) by Morice et al. Gynecol Oncol. 2004;95(2):414 author reply:414–6.PubMedGoogle Scholar
  33. 33.
    •• Zhang Q, Li W, Kanis MJ, Qi G, Li M, Yang X, et al. Oncologic and obstetrical outcomes with fertility-sparing treatment of cervical cancer: systematic review and meta-analysis. Oncotarget. 2017;8:46580–92 This is one of the largest meta-analysis to evaluate the rates of recurrence, survival, pregnancy and pregnancy outcomes of early-stage cervical cancer treated with fertility-sparing methods such as cervical conization and radical trachelectomy with or without pelvic lymphadenectomy.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Plante M, Renaud M-C, Francois H, Roy M. Vaginal radical trachelectomy: an oncologically safe fertility-preserving surgery. An updated series of 72 cases and review of the literature. Gynecol Oncol. 2004;94:614–23.PubMedGoogle Scholar
  35. 35.
    Roy M, Plante M. Pregnancies after radical vaginal trachelectomy for early-stage cervical cancer. Am J Obstet Gynecol. 1998;179(6):1491.PubMedGoogle Scholar
  36. 36.
    Steed H, Covens A. Radical vaginal trachelectomy and laparoscopic pelvic lymphadenopathy for preservation of fertility. Postgrad Obstet Gynecol. 2003;23:1.Google Scholar
  37. 37.
    Covens A. Preserving fertility in early stage cervical cancer with radical trachelectomy. Contemp Obstet Gynecol. 2003;48:46–66.Google Scholar
  38. 38.
    Shepherd JH, Spencer C, Herod J, Ind TEJ. 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. 2006;113(6):719–24.PubMedGoogle Scholar
  39. 39.
    Hertel H, Kohler C, Hillemanns P, et al. Radical vaginal trachelectomy (RVT) combined with laparoscopic pelvic lymphadenectomy; prospective multicenter study of 100 patients with early cervical cancer. Gynecol Oncol. 2006;103:506–11.PubMedGoogle Scholar
  40. 40.
    Dargent D, Martin X, Sacchetoni A, Mathevet P. Laparoscopic vaginal trachelectomy: a treatment to preserve the fertility of cervical carcinoma patients. Cancer. 2000;88:1877–82.PubMedGoogle Scholar
  41. 41.
    Mathevet P, Laszlo de Kaszon E, Dargent D. Fertility preservation in early cervical cancer. Gynecol Obstet Fertil. 2003;31:706.PubMedGoogle Scholar
  42. 42.
    Ungar L, Palfalvi L, Smith JR, et al. Update on and long term follow-up of 91 abdominal radical trachelectomies. Gynecol Oncol. 2006;101:S20.Google Scholar
  43. 43.
    Diaz JP, Sonoda Y, Leitao MM, et al. Oncologic outcome of fertility-sparing radical trachelectomy versus radical hysterectomy for stage IB1 cervical carcinoma. Gynecol Oncol. 2008;111(2):255.PubMedGoogle Scholar
  44. 44.
    Wethington, Cibula D, Duska LR, et al. An international series on abdominal radical trachelectomy: 101 patients and 28 pregnancies. Int J Gynecol Cancer. 2012;22:1251–7.PubMedGoogle Scholar
  45. 45.
    Burnett AF, Roman LD, O’meara AT, Morrow CP. Radical vaginal trachelectomy and pelvic lymphadenectomy for preservation of fertility in early cervical carcinoma. Gynecol Oncol. 2003;88:419–23.PubMedGoogle Scholar
  46. 46.
    Schlaerth JB, Spirtos NM, Schlaerth AC. Radical trachelectomy and pelvic lymphadenectomy with uterine preservation in the treatment of cervical cancer. Am J Obstet Gynecol. 2003;188:29–34.PubMedGoogle Scholar
  47. 47.
    Bernardini M, Barrett J, Seaward G, et al. Pregnancy outcome in patients post radical trachelectomy. Am J Obstet Gynecol. 2003;189:1378.PubMedGoogle Scholar
  48. 48.
    Kim CH, Abu-Rustum NR, Chi DS, et al. Reproductive outcomes of patients undergoing radical trachelectomy for early-stage cervical cancer. Gynecol Oncol. 2012;125(3):585.PubMedGoogle Scholar
  49. 49.
    Umemura K, Ishioka S, Endo T, et al. Changes of uterine blood flow after vaginal radical trachelectomy (VRT) in patients with early-stage uterine invasive cervical cancer. Int J Med Sci. 2010;7(5):260–6.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Makino H, Kato H, Furui T, Hayasaki Y, Morishige K, Kanematsu M. Assessment of uterine enhancement rate after abdominal radical trachelectomy using dynamic contrast-enhanced magnetic resonance imaging. Arch Gynecol Obstet. 2016;293(3):625–32.PubMedGoogle Scholar
  51. 51.
    Plante M, Renaud MC, Hoskins IA, Roy M. 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. 2005;98:3.PubMedGoogle Scholar
  52. 52.
    Kasuga Y, Miyakoshi K, Nishio H, et al. Mid-trimester residual cervical length and the risk of preterm birth in pregnancies after abdominal radical trachelectomy: a retrospective analysis. BJOG. 2017;124(11):1729–35.PubMedGoogle Scholar
  53. 53.
    Ishioka S, Endo T, Baba T, et al. Successful delivery after transabdominal cerclage of uterine cervix for cervical incompetence after radical trachelectomy. J Obstet Gynaecol Res. 2015;41(8):1295–9.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Anthony Costales
    • 1
    Email author
  • Chad Michener
    • 1
  • Pedro F. Escobar-Rodriguez
    • 2
  1. 1.Gynecologic Oncology Division, Cleveland ClinicOb/Gyn and Women’s Health InstituteClevelandUSA
  2. 2.Instituto Gyneco-OncólogicoSan JuanUSA

Personalised recommendations