Abdominal radical trachelectomy in West London

Authors


Dr S Saso, Clinical Research Fellow, Department of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, UK. Email srdjan.saso@imperial.ac.uk

Abstract

Please cite this paper as: Saso S, Ghaem-Maghami S, Chatterjee J, Naji O, Farthing A, Mason P, McIndoe A, Hird V, Ungar L, Del Priore G, Smith J. Abdominal radical trachelectomy in West London. BJOG 2012;119:187–193.

Objective  Traditionally, the surgical management of invasive cervical carcinoma that has progressed beyond microinvasion has been a radical abdominal hysterectomy. However, this results in the loss of fertility, with significant consequences for the young patient. This report describes abdominal radical trachelectomy (ART) as a potential replacement for radical hysterectomy in patients with stage IA2–IIA cervical cancer who desire a fertility-sparing procedure without decreasing the curative rates.

Design  Observational, retrospective study.

Setting  Teaching hospital and regional cancer centre in London, UK.

Population  Patients undergoing ART.

Methods  Patients presenting during the period 2000–2009 with cervical cancer stage IA2–IIA were offered a trachelectomy, if they expressed a desire to preserve fertility. The type of trachelectomy (vaginal/abdominal) was chosen based on patient anatomy and neoplastic and magnetic resonance imaging characteristics. Each patient was counselled as to the experimental nature of the procedure.

Main outcome measures  Survival, recurrence and fertility issues among ART patients.

Results  A total of 30 patients underwent ART (open and laparoscopic) between 2001 and 2009. Three patients presented with a recurrence, two of which have died (median follow-up: 24 months). Only three patients required further surgical re-intervention because of operative complications. Ten patients attempted to conceive, resulting in three conceptions (30%) and two live children.

Conclusions  Abdominal radical trachelectomy provides a feasible, cost-effective and safe treatment option for young women who have been diagnosed with early-stage cervical cancer and wish to preserve their fertility.

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