Fertility-sparing trachelectomy for early-stage cervical cancer: A proposal of an ideal candidate

Abstract

To propose an ideal patient candidate with early-stage cervical cancer for undergoing fertility-sparing trachelectomy.Methods.-This nationwide, multicenter, retrospective study was conducted by the Japan Society of Obstetrics and Gynecology involving women aged <45 years with clinical stage I-II cervical cancer who had planned fertility-sparing trachelectomy and pelvic lymphadenectomy between 2009 and 2013 (n = 393). Ideal candidates were defined to have a tumor size of ≤2 cm, no lymph node metastasis, no deep stromal invasion, and no high-risk histology (n = 284, 69.6%). Less-ideal candidates were defined to have any one of these four characteristics (n = 109, 30.4%). Propensity score inverse probability of treatment weighting was used to assess survival outcomes.Results.-Less-ideal candidates were more likely to undergo hysterectomy conversion (22.9% versus 3.2%), receive postoperative radiotherapy (11.9% versus 0.4%), or chemotherapy (32.1% versus 3.2%) compared with ideal candidates (all, P < 0.05). The weighted model revealed that among those who underwent trachelectomy (ideal candidates, n = 275 and less-ideal candidates, n = 84), less-ideal candidates had significantly decreased disease-free survival (5-year rates: 85.5% versus 95.5%; HR 3.93, 95% CI 1.99-7.74; P < 0.001) and cause-specific survival (92.5% versus 98.6%; HR 5.47, 95% CI 1.68-17.8, P = 0.001) compared with ideal candidates. Similarly, lessideal candidates were significantly associated with decreased disease-free survival compared with ideal candidates among those who were young age, had small tumors or squamous histology, and underwent surgery alone (all, P < 0.05).Conclusion.-Less-ideal candidates had approximately four-fold higher recurrence risk and cancer mortality compared with ideal candidates. Ideal candidates for fertility-sparing trachelectomy for early-stage cervical cancer proposed in our study may be useful as the future framework for developing guidelines for fertility-sparing trachelectomy in Japan.

Fertility-Sparing Surgery in Gynecologic Cancer: A Systematic Review

“…Of the 5598 screened articles, 153 met the predefined inclusion criteria and were assessed for their quality ( Figure 1 ) [ 8 , 14 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ,…”

A modified technique of laparoscopic radical trachelectomy combined with extracorporeal cervical amputation through a mini-laparotomy

“…Smith et al developed a new approach in 1997 called ART that is similar to the traditional radical hysterectomy and addresses the drawbacks of VRT [17]. The oncological safety of ART is guaranteed in early-stage cervical cancer, especially in cases with tumors smaller than 2 cm [18,19]. The first total laparoscopic radical trachelectomy was reported in 2002 by Pomel et al [20] and the first robot-assisted laparoscopic procedure in 2008 by Persson et al [21].…”

Cervical Cancer and Fertility-Sparing Treatment

“…Should the presence of LVSI in FIGO 2018 stage-IB1 tumors be an indication of radical trachelectomy as it was advised in Bentivegna’s review in 2016? A recent Japanese [ 24 ] study proposed different models to select patients for fertility-sparing trachelectomy; LVSI was not part of the final model that included the histology (squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma), tumor size ≤2 cm, nodal metastases and deep stromal invasion. The prospective GOG study [ 25 ] published in 1990 and other more recent studies showed that disease free-survival was worse among patients with LVSI [ 26 , 27 ], in contrast to a review published in 2004 [ 28 ].…”