Radical abdominal trachelectomy for cervical malignancies: Surgical, oncological and fertility outcomes in 62 patients

Li, Jin; Li, Ziting; Wang, Huaying; Zang, Rongyu; Zhou, Yuqi; Ju, Xingzhu; Ke, Guihao; Wu, Xiaohua

doi:10.1016/j.ygyno.2011.01.032

Cited by 80 publications

(57 citation statements)

References 36 publications

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“…(2) Modification of the classical RAT procedure has been described in the literature. (7,10) Evidence indicates that uterine perfusion can be maintained by the infundibulopelvic ligaments that contain the ovarian vessels, as demonstrated in our patient. (2) Other authors have opted to preserve the uterine arteries by ligating the descending branch to the cervix or reanastomosing the uterine vessels.…”

Section: Discussionsupporting

confidence: 64%

“…(6) Nevertheless, there has been an increasing number of cancer centres around the world using RAT due to its shorter learning curve, which is attributed to its similarity to traditional Wertheim's radical hysterectomy, and the possibility of removing more parametrial tissue via this procedure than a vaginal approach. (2,(7)(8)(9)(10) The eligibility criteria for RAT were adapted from that of RVT to include women aged < 40 years, those with a strong desire for fertility, cervical cancer from FIGO stage IA2 to IB1, histological examination showing squamous cell carcinoma or adenocarcinoma, tumour size < 2 cm (debatable for abdominal approach), no involvement of the upper endocervical canal, and negative for metastasis to the pelvic lymph nodes. (2) Modification of the classical RAT procedure has been described in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…(2) Other authors have opted to preserve the uterine arteries by ligating the descending branch to the cervix or reanastomosing the uterine vessels. (7,10) The role of the cervical cerclage is also controversial, with some authors preferring to insert a permanent cerclage at the time of surgery or during pregnancy. (2) In this case, we opted to insert the Ethibond suture at the level of the internal os after trachelectomy.…”

Section: Discussionmentioning

confidence: 99%

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Radical abdominal trachelectomy for stage IB1 cervical cancer in Singapore

Lim¹,

Chia²,

Quek³

et al. 2013

smedj

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CA S E R EPO RTA 35-year-old woman with stage IB1 cervical cancer diagnosed on cone biopsy was referred to a colposcopy clinic for a Pap smear, which revealed adenocarcinoma in situ in July 2010.Colposcopy revealed a large ectropion with a focus in the posterior lip, which was suspicious for adenocarcinoma in situ.Laser cone biopsy was performed and histopathology revealed a well-differentiated adenocarcinoma of the cervix measuring 16 mm × 14 mm. The radial margins were involved, but there was no lymphovascular space involvement. Chest radiography and magnetic resonance imaging of the abdomen and pelvis did not reveal any distant metastases. The patient shared her desire to retain fertility as she did not have any children.She was appropriately counselled, and subsequently consented to undergo RAT and bilateral pelvic lymphadenectomy in August 2010.RAT was performed based on the technique described by Abu-Rustum et al, (2) with some modifications (Figs. 1a-e).The procedure was carried out through a Maylard incision.Development of the obturator, paravesical and pararectal spaces was carried out, followed by systematic bilateral pelvic lymphadenectomy. The patient's pelvic lymph nodes, which were sent for histological frozen sectioning, were negative for malignancy. Next, the urinary bladder was mobilised down to the mid-vagina. The infundibulopelvic ligaments, which contain the ovarian vessels, were kept intact. A uterine clamp was used to manipulate the uterus and avoid damage to the fallopian tubes and ovarian vessels. The uterine arteries were ligated at its origin from the internal iliac arteries. The pouch of Douglas was entered and the uterosacral ligaments were taken. Both ureters were mobilised down to the base of the bladder before the parametrium could be taken. The vagina was entered with the aid of a LiNA McCartneyTube TM (LiNA Medical, Devon, UK). A vaginal cuff of 2 cm was taken. Clamps were then placed at the level of the internal os and the cervix was amputated at about 5 mm below the level of the internal cervical os. A shaved margin of the remaining endocervix was sent for frozen sectioning to determine the resection margins. Once the margins were revealed to be negative for malignancy on histopathology, a permanent cerclage was placed using Ethibond™ #0 suture (Ethicon Inc, NJ, USA)

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Radical abdominal trachelectomy for stage IB1 cervical cancer in Singapore

Lim¹,

Chia²,

Quek³

et al. 2013

smedj

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“…Several studies have been published and have proved the oncologic safety as well as the effectiveness in the maintenance of fertility potential of this procedure [1][2][3][4]. However, changes in menstrual patterns, which are unique postoperative manifestations that might impact patients' quality of life and obstetrical outcomes following radical trachelectomy, have not been thoroughly investigated.…”

Section: Introductionmentioning

confidence: 99%

Menstrual pattern after abdominal radical trachelectomy

2017

Gynecologic Oncology

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“…94 On the other hand Li et al reported that out of 14 cases who underwent ART with exophytic tumour size between 2-4cm, no evidence of recurrent disease during a follow-up period of 22.8 months was recorded. 95 Three patients received chemotherapy based on pathological findings. 95 Such significant survival differences might be the consequence of small sample sizes, short follow-up, variances in surgical radicality and the accuracy of intra-operative selection of high risk cases.…”

Section: Discussionmentioning

confidence: 99%

Fertility preserving treatments in different prognostic groups of cervical cancer patients

Balázs¹

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Radical abdominal trachelectomy for cervical malignancies: Surgical, oncological and fertility outcomes in 62 patients

Cited by 80 publications

References 36 publications

Radical abdominal trachelectomy for stage IB1 cervical cancer in Singapore

Radical abdominal trachelectomy for stage IB1 cervical cancer in Singapore

Menstrual pattern after abdominal radical trachelectomy

Fertility preserving treatments in different prognostic groups of cervical cancer patients

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