Laparoscopic vaginal radical trachelectomy

Dargent, D; Martín, Xavier; Sacchetoni, Amaloa; Mathevet, Patrice

doi:10.1002/(sici)1097-0142(20000415)88:8<1877::aid-cncr17>3.0.co;2-w

Cited by 396 publications

(65 citation statements)

References 7 publications

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“…Unlike described reports of vaginal radical trachelectomy [20], patients undergoing open or robotic radical trachelectomy in this series underwent removal of the entire parametria and transection of the uterine arteries at their origin on the basis of the literature which lacks data confirming decreased perfusion of the uterus and impairment of conception and pregnancy if the uterine vessels are removed in their entirety [21]. This approach is further supported by data that confirms involvement of parametrial lymph nodes among patients with small cervical tumors, even in the absence positive pelvic lymph nodes highlighting the importance of a complete parametrial excision [22].…”

Section: Discussionmentioning

confidence: 80%

Fertility sparing surgery for treatment of early-stage cervical cancer: Open vs. robotic radical trachelectomy

Nick

Frumovitz

Soliman

et al. 2012

Gynecologic Oncology

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Background To compare the open versus robotic surgical approaches and provide surgical outcome data on patients who have undergone radical trachelectomy (RT). Methods We identified patients who underwent open (ORT) or robotic radical trachelectomy (RRT) between September 2005–June 2011. Tumor characteristics, perioperative, operative and obstetrical outcomes were analyzed. Results Thirty-seven patients with early stage cervical cancer that desired future fertility underwent attempted radical trachelectomy, and 32 patients (20 with 1B1, 11 with 1A2, and 5 with 1A1 with LVSI/poorly differentiated histology) had successful completion of RT. Five (1 open/4 robotic) underwent conversion to radical hysterectomy secondary to close (<5mm) endocervical margin (p=0.08). The median age at diagnosis was 28.9 years (range; 21.4–37.2), 70% were nulliparous, and 9 had a visible lesion. Twenty-five patients (68%) underwent ORT and 12 (32%) underwent RRT. RRT was associated with less blood loss (62.5 mL vs. 300 mL, p=0.0001) and decreased length of postoperative stay (1 vs. 4 days, p<0.001), with no difference in operative time or histopathologic outcomes. Twenty-three patients (62%) had no residual cervical disease on final pathology. Common long-term morbidities were irregular menstrual bleeding or amenorrhea (25%), cerclage erosion (13%), or cervical stenosis (9%). Although there was a higher rate of conversion to hysterectomy in the robotic surgery cohort, rates of serious morbidities among the cohorts were comparable (robotic: 33% vs. open: 24%, p=0.70). Eleven (36%) patients are actively attempting pregnancy and three have achieved pregnancy. The median time of follow up is 17.0 months (range 0.30–64.9 months). There are no documented recurrences. Conclusions RRT results in less blood loss and decreased length of hospital stay with no compromise in histopathologic outcomes.

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Section: Discussionmentioning

confidence: 80%

Fertility sparing surgery for treatment of early-stage cervical cancer: Open vs. robotic radical trachelectomy

Nick

Frumovitz

Soliman

et al. 2012

Gynecologic Oncology

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“…[3][4][5][6] There have been a number of large series reported that demonstrate the efficacy and safety of radical trachelectomy, and confirm that this procedure can deliver a realistic chance of future pregnancy for many women treated for this disease. 3,4 Cervical cone biopsy is regarded as standard treatment for stage-1a1 cervical cancer, but some authors have questioned whether this procedure could be used for the treatment of highly selected stage-1a2 and -1b1 tumours that may not require as radical an excision as that offered by trachelectomy. 3,7 Shepherd et al 3 reported fertility rates, complications and recurrences in their series of radical vaginal trachelectomy (RVT) performed in non-pregnant women with early-stage cervical cancer.…”

Section: Discussionmentioning

confidence: 99%

A report of two cases of the management of cervical cancer in pregnancy by cone biopsy and laparoscopic pelvic node dissection

Herod

Decruze

Patel

2010

BJOG

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“…Although more than 300 pregnancies have been reported since Dargent reported his first series of radical trachelectomies in 1994 9,10,11, there are still few reports on pregnancy complications after RT. It is known that lack of a protective effect against vaginal infection or the lack of mechanical support of the residual cervix due to the dissection of the uterine cervix might be a cause of pPROM, and the following occurrence of preterm premature delivery.…”

Section: Discussionmentioning

confidence: 99%

Changes of uterine blood flow after vaginal radical trachelectomy (VRT) in patients with early-stage uterine invasive cervical cancer

Umemura¹,

Ishioka²,

Endo³

et al. 2010

Int. J. Med. Sci.

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Background. Vaginal radical trachectomy (RT) ligates and cuts several arteries supplying the uterus. Changes of blood supply to the uterus in two patients who experienced pregnancy and delivery were studied by using 3-D CT scanning. Effects of changes of blood supply to the uterus on the pregnancy courses were also examined.Methods. Vascular distribution in the uterus was studied in two patients who received vaginal RT after delivery. Effects of changes of vascular distribution after vaginal RT were studied with respect to pregnancy courses and cervical functions.Results. New arterial vascularization from the ascending branches of uterine arteries or other arteries occurred, and these new vessels seemed to supply blood to the remaining cervix. Differences of fetal growth and histopathological changes in the placenta between the two patients could not be detected.Conclusion. Ligation and cutting of several supplying arteries by RT induces new areterial vascularization and it does not seem to affect fetal growth and placental function.

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Laparoscopic vaginal radical trachelectomy

Cited by 396 publications

References 7 publications

Fertility sparing surgery for treatment of early-stage cervical cancer: Open vs. robotic radical trachelectomy

Fertility sparing surgery for treatment of early-stage cervical cancer: Open vs. robotic radical trachelectomy

A report of two cases of the management of cervical cancer in pregnancy by cone biopsy and laparoscopic pelvic node dissection

Changes of uterine blood flow after vaginal radical trachelectomy (VRT) in patients with early-stage uterine invasive cervical cancer

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