Short- and long term outcomes after abdominal radical trachelectomy versus radical hysterectomy for early stage cervical cancer: a systematic review of the literature and meta-analysis
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Cervical cancer (CC) ranks 2nd for mortality among women of reproductive age in the United States. Abdominal radical trachelectomy (ART) is a fertility sparing approach that has been proposed in women with early stage CC who wish to preserve their fertility. The aim of the present meta-analysis was to evaluate the short- and long-term outcomes of RH vs ART for early stage CC.
A total of 5 electronic databases were searched for articles published up to December 2018. Prospective and retrospective trials reporting outcomes for women who underwent ART or RH for the management of early stages CC, were considered eligible for inclusion. Statistical meta-analysis was performed using the RevMan 5.3 software.
A total of 5 studies which included 840 women who underwent ART or radical trachelectomy (RH) were included in the present meta-analysis. Among them, 324 underwent ART whereas the remaining 516 had RH. Despite the fact that ART was associated with significantly prolonged operative time compared to RH (840 patients MD 36.82 min, 95% CI 20.15–53.49, p < 0.001), neither 5-year OS nor 5-year DFS were different among the two groups (714 patients OR 1.39, 95% CI 0.53–3.62, p = 0.51 and 682 patients OR 1.08, 95% CI 0.52–2.25, p = 0.84, respectively).
ART is a more complex and time consuming technique, but equally safe compared to RH in terms of oncological outcomes for selected women with early stage CC and allows for more CC survivors of childbearing age to preserve their fertility.
KeywordsCervical cancer Fertility sparing Abdominal radical trachelectomy Radical hysterectomy
AP: data collection and management, data analysis, manuscript writing. CI: protocol/project development, manuscript writing. AF: data collection and manuscript writing. VP: manuscript writing. AD: manuscript writing. GV: protocol/project development, consultation to the manuscript. NK: protocol/project development, consultation to the manuscript.
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest and nothing to disclose.
- 3.Serati M, Salvatore S, Uccella S, Laterza RM, Cromi A, Ghezzi F, Bolis P (2009) Sexual function after radical hysterectomy for early-stage cervical cancer: is there a difference between laparoscopy and laparotomy? J Sex Med 6(9):2516–2522. https://doi.org/10.1111/j.1743-6109.2009.01363.x CrossRefGoogle Scholar
- 6.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 CrossRefGoogle Scholar
- 7.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700. https://doi.org/10.1136/bmj.b2700 CrossRefGoogle Scholar
- 11.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 CrossRefGoogle Scholar
- 14.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 CrossRefGoogle Scholar
- 16.Li X, Li J, Wen H, Ju X, Chen X, Xia L, Ke G, Tang J, Wu X (2016) The Survival rate and surgical morbidity of abdominal radical trachelectomy versus abdominal radical hysterectomy for stage IB1 cervical cancer. Ann Surg Oncol 23(9):2953–2958. https://doi.org/10.1245/s10434-016-5216-1 CrossRefGoogle Scholar
- 17.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 CrossRefGoogle Scholar
- 18.Yoshihara K, Ishiguro T, Chihara M, Shima E, Adachi S, Isobe M, Haino K, Yamaguchi M, Sekine M, Kashima K, Takakuwa K, Nishikawa N, Enomoto T (2018) The safety and effectiveness of abdominal radical trachelectomy for early-stage cervical cancer during pregnancy. Int J Gynecol Cancer 28(4):782–787. https://doi.org/10.1097/igc.0000000000001218 CrossRefGoogle Scholar
- 21.Dargent D (1994) Pregnancies following radical trachelectomy for invasive cervical cancer. Gynecol Oncol 52:105Google Scholar
- 22.Cao DY, Yang JX, Wu XH, Chen YL, Li L, Liu KJ, Cui MH, Xie X, Wu YM, Kong BH, Zhu GH, Xiang Y, Lang JH, Shen K (2013) Comparisons of vaginal and abdominal radical trachelectomy for early-stage cervical cancer: preliminary results of a multi-center research in China. Br J Cancer 109(11):2778–2782. https://doi.org/10.1038/bjc.2013.656 CrossRefGoogle Scholar
- 27.Pareja R, Rendon GJ, Vasquez M, Echeverri L, Sanz-Lomana CM, Ramirez PT (2015) Immediate radical trachelectomy versus neoadjuvant chemotherapy followed by conservative surgery for patients with stage IB1 cervical cancer with tumors 2 cm or larger: a literature review and analysis of oncological and obstetrical outcomes. Gynecol Oncol 137(3):574–580. https://doi.org/10.1016/j.ygyno.2015.03.051 CrossRefGoogle Scholar