Skip to main content
SpringerLink
Log in

Radical Vaginal Trachelectomy with Laparoscopic Pelvic Lymphadenectomy for Fertility Preservation in Young Women with Early-Stage Cervical Cancer

  • Original Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

The primary objective of this study was to describe our experience with the conservative treatment of early-stage cervical cancer (stages IA1, IA2, and IB1) with radical vaginal trachelectomy (RVT) and laparoscopic pelvic lymphadenectomy. This retrospective observational case series included 36 patients with early cervical cancer. Radical trachelectomy and laparoscopic pelvic lymphadenectomy were performed as described by D. Dargent in 32 of these cases. Oncologic, reproductive, and obstetric outcomes were observed subsequently over a median period of 42 (24–96) weeks. A total of 32 RVTs were preformed with a mean operating time of 117 ± 22.8 (77–167) minutes and an average blood loss of 486 mL (150–800 mL). All obtained resection margins were negative for cancer. Lymphovascular space invasion was noted in 11 (30.55 %) of the cases. No recurrences occurred during the study period. Seven (17.8 %) patients were able to become pregnant postoperatively, five of whom delivered healthy infants near term. Radical vaginal trachelectomy with laparoscopic pelvic lymphadenectomy appears to be a safe therapeutic option for fertility preservation in young women with early cervical cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JWW, Comber H, Forman D, Bray F (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49:1374–1403

    Article  CAS  PubMed  Google Scholar 

  2. Surveillance, Epidemiology and End Results (SEER) (2011) Available from http://www.seer.cancer.gov/statfacts/html/cervix.html. Accessed 5 Sept 2011

  3. Ramirez PT, Schmeler KM, Soliman PT, Frumovitz M (2008) Fertility preservation in patients with early cervical cancer: radical trachelectomy. Gynecol Oncol 110(3):s25–s28

    Article  PubMed  Google Scholar 

  4. Chiricuta I (1981) Colpohisterectomia largita subfundica. In: Sirbu P (ed) Chirurgia ginecologica. Editura Medicala, Bucuresti, pp 714–722

    Google Scholar 

  5. Aburel E (1973) Proceedings: extended abdominal exstirpation of cervix and isthmus in early stages of cervix carcinoma (carcinoma in situ and microcarcinoma). Arch Gynakol 214:106–108

    Article  CAS  PubMed  Google Scholar 

  6. Speiser D, Köhler C, Schneider A, Mangler M (2013) Radical vaginal trachelectomy: a fertility-preserving procedure in early cervical cancer in young women. Dtsch Arztebl Int 110(17):289–295

    PubMed  PubMed Central  Google Scholar 

  7. Dargent D, Brun JL, Roy M, Remi I (1994) Pregnancies following radical trachelectomy for invasive cervical cancer. Gynecol Oncol 52:abstr 105

  8. Dargent D, Brun J, Roy M et al (1994) La trachelectomie elargie (T.E.) une alternative à l’hysterectomie radicale dans le traitement des cancers infiltrants developpes sur la face externe du col uterin. J Obstet Gynaecol 2:285–292

    Google Scholar 

  9. Roy M, Plante M (1998) Pregnancies after radical vaginal trachelectomy for early-stage cervical cancer. Am J Obstet Gynecol 179(6):1491–1496

    Article  CAS  PubMed  Google Scholar 

  10. Covens A, Shaw P, Murphy J (1999) Is radical trachelectomy a safe alternative to radical hysterectomy for patients with stage IA-B carcinoma of the cervix? Cancer 86:2273–2279

    Article  CAS  PubMed  Google Scholar 

  11. Cubal AFR, Carvalho JIF, Costa MF, Branco APT (2012) Fertility-sparing surgery for early-stage cervical cancer. Int J Surg Oncol 2012, 936534, 11 pages

    Google Scholar 

  12. Rob L, Charvat M, Robova H et al (2007) Less radical fertility-sparing surgery than radical trachelectomy in early cervical cancer. Int J Gynecol Cancer 17:304–310

    Article  CAS  PubMed  Google Scholar 

  13. Diaz JP, Sonoda Y, Leitao MM et al (2008) Oncologic outcome of fertility-sparing radical trachelectomy versus radical hysterectomy for stage IB1 cervical carcinoma. Gynecol Oncol 111(2):255–260

    Article  PubMed  Google Scholar 

  14. Lanowska M, Mangler M, Speiser D, Bockholdt C, Schneider A, Köhler C, Vasiljeva J, Al-Hakeem M, Vercellino GF (2014) Radical vaginal trachelectomy after laparoscopic staging and neoadjuvant chemotherapy in women with early-stage cervical cancer over 2 cm: oncologic, fertility, and neonatal outcome in a series of 20 patients. Int J Gynecol Cancer 24(3):586–593

    Article  PubMed  Google Scholar 

  15. Knight LJ, Acheson N, Kay TA, Renninson JN, Shepherd JH, Taylor MJO (2010) Obstetric management following fertility-sparing radical vaginal trachelectomy for cervical cancer. J Obstet Gynaecol 30:784–789

    Article  CAS  PubMed  Google Scholar 

  16. Bratila E., Bratila P.C The modulation of radicality of the surgical treament in early cervical cancer Gineco.ro, 2011, an VII, volume VII, nr.27, pg. 100–105

  17. Pahisa IA, Torné A (2008) Vaginal approaches to fertility-sparing surgery in invasive cervical cancer. Gynecol Oncol 110(3):s29–s32

    Article  PubMed  Google Scholar 

  18. Cao D et al (2014) Oncologic and fertility outcomes of young patients with early stage of cervical cancer treated by vaginal radical trachelectomy. Zhonghua Fu Chan Ke Za Zhi 49(4):249–253

    Google Scholar 

  19. Wagenaar HC, Trimbos JBMZ, Postema S, Anastasopoulou A, Van Der Geest RJ, Reiber JHC (2001) Tumor diameter and volume assessed by magnetic resonance imaging in the prediction of outcome for invasive cervical cancer. Gynecol Oncol 82:474–482

    Article  CAS  PubMed  Google Scholar 

  20. Noël P, Dubé M, Plante M, St-Laurent G (2014) Early cervical carcinoma and fertility-sparing treatment options: MR imaging as a tool in patient selection and a follow-up modality. Radiographics 34(4):1099–1119

    Article  PubMed  Google Scholar 

  21. Marchiole P, Benchaib M, Buenerd A et al (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 106:132–141

    Article  PubMed  Google Scholar 

  22. Burnett AF, Roman LD, O’Meara AT, Morrow CP (2003) Radical vaginal trachelectomy and pelvic lymphadenectomy for preservation of fertility in early cervical carcinoma. Gynecol Oncol 88(3):419–423

    Article  PubMed  Google Scholar 

  23. Milliken J, David A, Shepherd JH (2008) Fertility preserving surgery for carcinoma of the cervix. Curr Opin Oncol 20(5):575–580

    Article  PubMed  Google Scholar 

  24. Ebisawa K, Takano M, Fukuda M, Fujiwara K, Hada T, Ota Y, Kurotsuchi S, Kanao H, Andou M (2013) Obstetric outcomes of patients undergoing total laparoscopic radical trachelectomy for early stage cervical cancer. Gynecol Oncol 131(1):83–86

    Article  PubMed  Google Scholar 

  25. Chênevert J, Têtu B, Plante M, Roy M, Renaud MC, Gregoire (2009) Indication and method of frozen section in vaginal radical trachelectomy. Int J Gynecol Pathol 28(5):480–488

    Article  PubMed  Google Scholar 

  26. Bernardini M, Barrett J, Seaward G, Covens A (2003) Pregnancy outcomes in patients after radical trachelectomy. Am J Obstet Gynecol 189(5):1378–1382

    Article  PubMed  Google Scholar 

  27. Ma LK, Cao DY, Yang JX (2014) Pregnancy outcome and obstetric management after vaginal radical trachelectomy. Eur Rev Med Pharmacol Sci 18(20):3019–3024

    PubMed  Google Scholar 

  28. 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

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of Interest

The authors declare that they have no competing interests

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

    Elvira Brătilă & C. P. Brătilă

  2. Department of Obstetrics and Gynecology, Clinical Emergency Hospital “Sf. Pantelimon”, Sos. Pantelimon, nr. 340-342, Postal code 021659, Bucharest, Romania

    Elvira Brătilă & C. B. Coroleuca

  3. Minimally Invasive Surgery Hospital Euroclinic “Regina Maria”, Bucharest, Romania

    C. P. Brătilă

Authors
  1. Elvira Brătilă
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. P. Brătilă
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. B. Coroleuca
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elvira Brătilă.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brătilă, E., Brătilă, C.P. & Coroleuca, C.B. Radical Vaginal Trachelectomy with Laparoscopic Pelvic Lymphadenectomy for Fertility Preservation in Young Women with Early-Stage Cervical Cancer. Indian J Surg 78, 265–270 (2016). https://doi.org/10.1007/s12262-015-1351-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-015-1351-3

Keywords

Search

Navigation