Role of cervical cytology in surveillance after radical trachelectomy for cervical cancer

Abstract

Objective There are currently no standard guidelines on the use of Papanicolaou (Pap) tests for surveillance after radical trachelectomy for cervical cancer. The goal of this study was to determine the usefulness of Pap tests in routine surveillance after radical trachelectomy for cervical cancer. Methods Cervical cancer patients who underwent radical trachelectomy from January 2004 through October 2015 and subsequently had at least one Pap test were retrospectively identified. Demographic and clinical characteristics were described and compared between patients with and without at least one abnormal Pap test. The Kaplan-Meier method was used to estimate time to first abnormal Pap test. Results Forty-one patients met inclusion criteria. Of these, 30 (73%) had at least one year in which more than one Pap test per year was obtained. Twenty-four (59%) had at least one abnormal Pap test. Of 238 total Pap tests collected, 44 (18%) were abnormal. The most common abnormality was ASCUS (52%, n=23). Other findings included LSIL (20%, n=9), HSIL (2%, n=1), and AGUS (25%, n=11). Median time from radical trachelectomy to first abnormal Pap test was 17.2 months (range, 11.8–86.3). No patient had disease recurrence. Surgery type (laparoscopic, open, or robotic), trachelectomy specimen size, histology, device for stenosis prevention (pediatric Foley catheter or Smit Sleeve), and cerclage placement were not significant predictors of an abnormal Pap test. Conclusions The rate of abnormal Pap tests after radical trachelectomy is high; however, the clinical significance of such abnormalities appears limited. The routine use of cervical cytology as surveillance after radical trachelectomy does not appear to substantially impact management decisions.

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

“…Gynecological examination, if possible under sedation, is important to assess disease characteristics, invasion of adjacent structures, and extension to the pelvic wall. Palpation of the inguinal and supraclavicular lymph nodes is mandatory …”

“…Patients who will undergo PE surgery should have their cases, whenever possible, previously discussed by a multidisciplinary team, which should be composed of the clinical/surgical medical staff, a physiotherapist, a nurse, a psychologist, a stomatotherapist, and a nutritionist …”

Simple Vaginal Trachelectomy

“…These anomalies lead to extensive investigations and generate high levels of anxiety. In the series of Brown et al, 21 up to 59% of the patients had at least 1 abnormal Pap test during follow-up after radical trachelectomy, yet none developed a cancer recurrence. They concluded that the routine use of cervical cytology as surveillance after radical trachelectomy does not appear to substantially impact management decisions.…”

“…They concluded that the routine use of cervical cytology as surveillance after radical trachelectomy does not appear to substantially impact management decisions. 21 Moreover, Slama et al 22 analyzed their recurrence pattern after trachelectomy and noted that most of the recurrences were central or pelvic. Only 2 patients were symptomatic.…”

Fertility-Sparing Surgery In Early Stage Cervical Cancer

“…Regardless of the results obtained, no recurrence was found in 41 patients involved in the study. 71 Many centers implement MRI examinations at 6, 12, and 18 months. However, the interpretations are often difficult due to anatomical changes.…”