Trends in Use and Survival Associated With Fertility-Sparing Trachelectomy for Young Women With Early-Stage Cervical Cancer

Abstract

Use of trachelectomy for early-stage cervical cancer has increased in the United States, particularly among women younger than 30 years of age. Within this population, survival is similar for trachelectomy and hysterectomy.

Trachelectomy for stage IB1 cervical cancer with tumor size >2 cm: trends and characteristics in the United States

“…Although performance of trachelectomy remained uncommon, our study showed a gradual increase in the utilization of trachelectomy for reproductive-aged women with stage IB1 cervical cancer with tumors larger than 2 cm in the United States. Our results partly support the recent study using the National Cancer Database that demonstrated a significant increase in the utilization of fertility-sparing trachelectomy for women aged younger than 30 years with early-stage cervical cancer in the United States [ 6 ]. However, population-based statistics specific to stage IB1 cervical cancer with tumor size larger than 2 cm have not been examined previously.…”

Trachelectomy for reproductive-aged women with early-stage cervical cancer: minimally invasive surgery versus laparotomy

“…8 This increase was most pronounced in women <30 years of age. 5 Our study demonstrates that the majority of these procedures are now performed with a minimally invasive approach, particularly with use of the robotic platform. This increased use of MIS for trachelectomy parallels the trends observed for radical hysterectomy for early-stage cervical cancer in the United States.…”

“…The following abstracted data variables were categorized based on a previous study. 5 Demographic information of interest included age (in years), race/ ethnicity (white, black, Hispanic, other, or unknown), year of diagnosis, insurance type (private, Medicare, Medicaid, uninsured, other government or unknown), median household income (<$38,000, $38,000e47,999, $48,000e62,999, $63,000), education (measured as percentage of adults in the patient's zip code who did not graduate from high school and grouped as 21%, 13%e20%, 7.0%e12.9%, <7%), and urbanerural location (metropolitan, urban, rural, or unknown).…”

“…4 Mounting evidence has demonstrated the oncologic safety and subsequent favorable pregnancy outcomes in reproductive-aged women with earlystage cervical cancer who desire fertility preservation. [5][6][7][8][9][10] A previous study in the United States has shown that w40% of women aged <40 years who underwent definitive surgical treatment with radical hysterectomy actually expressed interest for fertility preservation and nearly one half were indeed candidates for fertilitysparing trachelectomy based on their surgicalepathologic factors. 11 In the past several years, there has been a significant recent increase in the use of trachelectomy in this population in the United States.…”

“…11 In the past several years, there has been a significant recent increase in the use of trachelectomy in this population in the United States. 5,8,12 One clinical entity that has not been addressed in the literature regarding trachelectomy for cervical cancer is the oncologic safety of minimally invasive surgery (MIS) as compared with laparotomy and radical vaginal trachelectomy, which remains unknown. Given the results of a recent randomized trial and an observational study that demonstrated decreased survival with MIS radical hysterectomy in women with early-stage cervical cancer, this clinical question is of great importance.…”