ObjectiveAbdominal radical trachelectomy (ART) is one of the fertility-sparing procedures in women with early-stage cervical cancer. The published results of ART, in comparison with vaginal radical trachelectomy, so far are limited.Materials and MethodsThis retrospective study comprises all cases of female patients referred to ART with early-stage cervical cancer from 2 gynecologic oncology centers in Romania.ResultsA total of 29 women were referred for ART, but subsequently, fertility could not be preserved in 3 of them. Eleven women had stage IA2 disease (42.3%), 14 (53.8%) women had stage IB1 disease, and 1 (3.8%) woman had stage IB2 disease. Histologic subtypes were 15 (57.6%) squamous, 8 (30.7%) adenocarcinoma, and 3 (11.5%) adenosquamous. There were no major intraoperative complications in both hospitals. Early postoperative complications were mainly related to the type C parametrectomy—bladder dysfunction for more than 7 days (8 [30.7%] women) and prolonged constipation (6 [23.0%] women). Other complications consisted in symptomatic lymphocele in 2 (7.6%) patients, which were drained. Median follow-up time was 20 months (range, 4–43 months). Up to the present time, there has been 1 (3.8%) recurrence in our series. Most patients did not experience late postoperative complications. Three (11.5%) women are amenorrheic, and 1 (3.8%) woman developed a cervical stenosis. Of the 23 women who have normal menstruation and maintained their fertility, a total of 7 (30.4%) women have attempted pregnancy, and 3 (42.8%) of them achieved pregnancy spontaneously. These pregnancies ended in 2 first trimester miscarriages and 1 live birth at term by cesarean delivery.ConclusionsOur results demonstrate that ART preserves fertility and maintains excellent oncological outcomes with low complication rates.

BackgroundRadical trachelectomy is considered a viable option for fertility preservation in patients with low-risk, early-stage cervical cancer. Standard approaches include laparotomy or minimally invasive surgery when performing radical trachelectomy.Primary ObjectiveTo compare disease-free survival between patients with FIGO (2009) stage IA2 or IB1 (≤2cm) cervical cancer who underwent open versus minimally invasive (laparoscopic or robotic) radical trachelectomy.Study HypothesisWe hypothesize that minimally invasive radical trachelectomy has similar oncologic outcomes to those of the open approach.Study DesignThis is a collaborative, multi-institutional, international, retrospective study. Patients who underwent a radical trachelectomy and lymphadenectomy between January 1, 2005 and December 31, 2017 will be included. Institutional review board approval will be required. Each institution will be provided access to a study-specific REDCap (Research Electronic Data Capture) database maintained by MD Anderson Cancer Center and will be responsible for entering patient data.Inclusion CriteriaPatients with squamous, adenocarcinoma, or adenosquamous cervical cancer FIGO (2009) stages IA2 and IB1 (≤2 cm) will be included. Surgery performed by the open approach or minimally invasive approach (laparoscopy or robotics). Tumor size ≤2 cm, by physical examination, ultrasound, MRI, CT, or positron emission tomography (at least one should confirm a tumor size ≤2 cm). Centers must contribute at least 15 cases of radical trachelectomy (open, minimally invasive, or both).Exclusion CriteriaPrior neoadjuvant chemotherapy or radiotherapy to the pelvis for cervical cancer at any time, prior lymphadenectomy, or pelvic retroperitoneal surgery, pregnant patients, aborted trachelectomy (intra-operative conversion to radical hysterectomy), or vaginal approach.Primary EndpointThe primary endpoint is disease-free survival measured as the time from surgery until recurrence or death due to disease. To evaluate the primary objective, we will compare disease-free survival among patients with FIGO (2009) stage IA2 or IB1 (≤2cm) cervical cancer who underwent open versus minimally invasive radical trachelectomy.Sample SizeAn estimated 535 patients will be included; 256 open and 279 minimally invasive radical trachelectomy. Previous studies have shown that recurrence rates in the open group range from 3.8% to 7.6%. Assuming that the 4.5-year disease-free survival rate for patients who underwent open surgery is 95.0%, we have 80% power to detect a 0.44 HR using α level 0.10. This corresponds to an 89.0% disease-free survival rate at 4.5 years in the minimally invasive group.

ObjectiveCervical cancer is one of the most frequent malignant diseases diagnosed during pregnancy. Abdominal or vaginal radical trachelectomies are fertility-preserving alternatives to radical hysterectomy for young women with early-stage cervical cancer that can be performed during ongoing pregnancy.MethodsA literature review of articles on this subject was conducted through a Medline search for articles published in English or French.ResultsAt this moment, 21 cervical cancer patients, including ours (4 stage IA2, 16 IB1, and 1 IB2) who underwent radical trachelectomy during pregnancy have been reported. Of these, 10 were performed by vaginal route and 11 were abdominal radical trachelectomies.ConclusionsRadical trachelectomy could be offered as an option for pregnant patients with early invasive cervical cancer. It may help women avoid the triple losses of a desired pregnancy, fertility, and motherhood.

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Cele mai multe centre oncologice din lume recomandă actualmente în cancerul de col uterin avansat loco-regional (LACC) chimioradioterapie (fără chirurgie). În România, în practica clinică, un număr însemnat de paciente cu LACC sunt încă îndrumate către serviciile de chirurgie. Un grup de experţi în oncologie şi chirurgie oncologică (grupul de studiu SURCECAN-surgery of cervical cancer) din România şi-au propus să analizeze cauzele acestei opţiuni. Au constat că nici indicaţiile terapeutice din literatura de specialitate nu sunt consensuale. Condiţiile practice de realizare a radioterapiei (inclusiv brahiterapie) prezintă în România unele particularităţi: accesibilitate limitată la centrele specializate, dispoziţie geografică neuniformă, etc. Pe de altă parte, şi statisticile din România şi cele internaţionale arată prezenţa de ţesut tumoral restant după iradiere. În aceste condiţii, se poate spune că, în cazuri selectate, chirurgia păstrează încă un rol în tratamentul LACC. Este de dorit ca criteriile de indicaţie operatorie şi de abord

ObjectivesTo assess the survival of patients who have received an operation for recurrent cervical and endometrial cancer and to determine prognostic variables for improved oncologic outcome.MethodsA retrospective multicenter analysis of the medical records of 518 patients with cervical (N = 288) or endometrial cancer (N = 230) who underwent surgery for disease recurrence and who had completed at least 1 year of follow-up.ResultsThe median survival reached 57 months for patients with cervical cancer and 113 months for patients with endometrial cancer after surgical treatment of recurrence (p = 0.036). Histological sub-type had a significant impact on overall survival, with the best outcome in endometrial endometrioid cancer (121 months), followed by cervical squamous cell carcinoma, cervical adenocarcinoma, or other types of endometrial cancer (81 vs 35 vs 35 months; p<0.001). The site of recurrence did not significantly influence survival in cervical or in endometrial cancer. Cancer stage at first diagnosis, tumor grade, lymph node status at recurrence, progression-free interval after first diagnosis, and free resection margins were associated with improved overall survival on univariate analysis. On multivariate analysis, the stage at first diagnosis and resection margins were significant independent predictive parameters of an improved oncologic outcome.ConclusionLong-term survival can be achieved via secondary cytoreductive surgery in selected patients with recurrent cervical and endometrial cancer. An excellent outcome is possible even if the recurrence site is located in the lymph nodes. The possibility of achieving complete resection should be the main criterion for patient selection.

Retrospective study which included 133 patients with uterine cervical cancer with or without neoadjuvant therapy based on prognostic factors and correlations between NLR and MNM values, markers that were analyzed as continuous variables. This study aimed to establish the critical value of hematological markers. NLR is significantly lower for preoperative stages I and II (p = 0.0004). There is a significant association between NLR and lymph node metastasis (p = 0.016), parametrial invasion (p = 0.035), lymphovascular space invasion (p = 0.0151) and tumor size (p = 0.0017). Correlational analysis showed that there is a significant association between MNM and lymph node metastasis (p = 0.020), parametrial invasion (p = 0.00010), lymphovascular space invasion materially affecting the value MNM (p = 0.0018), tumor size more than 4 cm (p = 0.0314). NLR and MNM were significantly lower in patients with complete response to neoadjuvant treatment. The results of this study outlines the importance of hematological panel and parameters that can be easily used at no extra cost to establish further evolution of patients to treatment.

IntroductionIn the early 1990s, the laparoscopic approach in uterine cervical cancer has started to become quite popular among oncologist surgeons in order to minimize postoperative morbidity. When a new surgical technique is taken into consideration or suggested, it is compared with the standard therapy hitherto. Important issues to be taken into account include the feasibility and applicability of the new technique, intraoperative and postoperative complications and in oncological cases, survival and risk of recurrence.Gold standard for uterine cervical cancer in the early stages was abdominal radical hysterectomy with pelvic lymphadenectomy for more than 100 years. This technique, described for the first time Wertheim, Meigs subsequently underwent some changes. The first laparoscopic hysterectomy was performed and published in 1989 [1], but the first laparoscopic radical hysterectomy with pelvic and paraaortic lymphadenectomy in a patient with cervical cancer stage IA2 was performed by Nezha et al. in June 1989 and reported in 1992 [2]. Since then, it has been reported in the literature over 1000 cases [3]. Laparoscopic Surgery versus Open Surgery in Uterine Cervical CancerInitially used for diagnostic, laparoscopy has become a method of treatment in the field of gynecological surgery, but also in many other field. The results of laparoscopic surgery are now comparable with those obtained by laparotomy in benign and malignant pathologies. The most important advantages of the laparoscopic technique include more pleasing cosmetic appearance, or minimum parietal infectious complications, low incidence of adhesion formation, low cost associated with hospitalization and recovery period smaller resumption of daily activities in a shorter period [4]. In a study comparing the two surgical techniques, the results show an average of operating time with significant differences statistically 231.7 minutes for cases treated laparoscopically and 207 minutes to classical surgery, which can be explained by the fact that laparoscopic hysterectomies implemented quite recently requires a learning curve. The surgeons will become more familiar with laparoscopic procedure; the operative time is expected to become shorter. Intraoperative blood loss was lower in the laparoscopy (161.1 ml) compared with the traditional method (394.4 ml), with blood transfusions in 3 patients. Postoperative complications, represented mostly wound infections were recorded only in the group that received radical abdominal hysterectomy. The hospital stay was less in laparoscopic interventions (mean=2.9 days) compared with the second procedure (mean=5. A randomized, multicenter study including 116 patients demonstrated that laparoscopic assisted vaginal hysterectomy can be performed in a similar operating time classic surgery with intraoperative blood loss less and a relatively shorter period of hospitalization (p<0.01). Postoperative pain, another important parameter discussed, is lower for the first 3 days of laparoscopy versus open surgery (p<0.5) [7]....