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Radical Trachelectomy for Early Stage Cervical Cancer

  • Gynecologic Cancers (LA Cantrell, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

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.

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References and Recommending Reading

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  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. SEER Cancer Stat Facts: Cervical Cancer. National Cancer Institute. Bethesda, MD. https://seer.cancer.gov/statfacts/html/cervix.html. Accessed 15 July 2018

  3. Rob L, Skapa P, Robova H. Fertility-sparing surgery in patients with cervical cancer. Lancet Oncol. 2011;12:192–200.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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. 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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. 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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  35. Roy M, Plante M. Pregnancies after radical vaginal trachelectomy for early-stage cervical cancer. Am J Obstet Gynecol. 1998;179(6):1491.

    Article  CAS  PubMed  Google Scholar 

  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. Covens A. Preserving fertility in early stage cervical cancer with radical trachelectomy. Contemp Obstet Gynecol. 2003;48:46–66.

    Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  41. Mathevet P, Laszlo de Kaszon E, Dargent D. Fertility preservation in early cervical cancer. Gynecol Obstet Fertil. 2003;31:706.

    Article  CAS  PubMed  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  47. Bernardini M, Barrett J, Seaward G, et al. Pregnancy outcome in patients post radical trachelectomy. Am J Obstet Gynecol. 2003;189:1378.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Gynecologic Oncology Division, Cleveland Clinic, Ob/Gyn and Women’s Health Institute, 9500 Euclid Avenue, Desk A81, Cleveland, OH, 44195, USA

    Anthony Costales MD & Chad Michener MD

  2. Instituto Gyneco-Oncólogico, 252 San Jorge St, San Juan, PR, 00914, USA

    Pedro F. Escobar-Rodriguez MD, MHL

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  1. Anthony Costales MD
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  3. Pedro F. Escobar-Rodriguez MD, MHL
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Correspondence to Anthony Costales MD.

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This article is part of the Topical Collection on Gynecologic Cancers

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Costales, A., Michener, C. & Escobar-Rodriguez, P.F. Radical Trachelectomy for Early Stage Cervical Cancer. Curr. Treat. Options in Oncol. 19, 75 (2018). https://doi.org/10.1007/s11864-018-0591-4

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