Twenty years of experience with less radical fertility-sparing surgery in early-stage cervical cancer: Oncological outcomes
Language English Country United States Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
34330536
DOI
10.1016/j.ygyno.2021.07.031
PII: S0090-8258(21)00593-X
Knihovny.cz E-resources
- Keywords
- Cervical cancer, Less radical fertility-sparing surgery, Oncological outcomes, Sentinel lymph node mapping,
- MeSH
- Adult MeSH
- Hysterectomy * MeSH
- Humans MeSH
- Neoplasm Recurrence, Local epidemiology MeSH
- Lymph Node Excision * MeSH
- Young Adult MeSH
- Uterine Cervical Neoplasms mortality pathology surgery MeSH
- Prospective Studies MeSH
- Neoplasm Staging MeSH
- Trachelectomy MeSH
- Fertility Preservation * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
INTRODUCTION: The standard procedure in cervical cancer is radical hysterectomy (RH) and pelvic lymphadenectomy (PLND). Because of the increasing age of women at childbirth, fertility becomes a major challenge. We present 20 years of experience with two-step less radical fertility-sparing surgery in women with IA1, LVSI positive, IA2 and IB1 (<2 cm, infiltration less than half of stromal invasions. MATERIALS AND METHOD: Preoperative workout consisted of histopathological diagnosis and magnetic resonance imaging along with ultrasonographic volumetry. We then performed laparoscopic sentinel lymph node mapping (SLNM) with frozen section (FS) followed by PLND and "selective parametrectomy" (removal of afferent lymphatic channels from the paracervix) in case of a negative result. If verified by definitive histopathology, patients were treated by simple trachelectomy (IB1) or large cone (IA1/IA2) biopsy 1 week after primary surgery. RESULTS: From 1999 to 2018, 91 women were enrolled in the study (median age 29.1 years, range 21-40). Of these 91 women, 51 (56.0%) were nulliparous. The detection rate of SLNs was 100% per patient and the specific side detection rate 96.7%. Positive lymph nodes were diagnosed in nine cases (9.8%). These women then underwent RH. Fertility was spared in 80 women but 4 recurred locally (5.0%). The mortality rate was 0.0%. The median follow-up was 149 months. CONCLUSION: Less radical fertility-sparing surgery with SLNM is safe in cervical cancers <2 cm at the largest diameter and infiltrating less than half of the cervical stroma. The recurrence rate is acceptable with no mortality. Morbidity with this procedure is low. Extended and accurate follow-up is necessary and human papillomavirus - high risk (HPV-HR tests seem to be useful in such follow-up assessment.
Medical Faculty Charles University Department of Obstetrics and Gynaecology Czech Republic
Medical Faculty Charles University Department of Pathology Czech Republic
Medical Faculty Charles University Department of Radiology Czech Republic
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