Cervical conization and lymph node assessment for early stage low-risk cervical cancer

2021 ◽  
Vol 31 (3) ◽  
pp. 447-451
Author(s):  
Andra Nica ◽  
Zbigniew Marchocki ◽  
Lilian T Gien ◽  
Rachel Kupets ◽  
Danielle Vicus ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Early Stage ◽  
Low Risk ◽  
Obstetric Outcomes ◽  
Pathologic Features ◽  
Fertility Sparing ◽  
Lymph Node Assessment ◽  
Early Cervical Cancer ◽  
Cervical Conization

ObjectiveThere has been a contemporary shift in clinical practice towards tailoring treatment in patients with early cervical cancer and low-risk features to non-radical surgery. The objective of this study was to evaluate the oncologic, fertility, and obstetric outcomes after cervical conization and sentinel lymph node (SLN) biopsy in patients with early stage low-risk cervical cancer.MethodsWe conducted a retrospective review in patients with early cervical cancer treated with cervical conization and lymph node assessment between November 2008 and February 2020. Eligibility criteria included patients with a histologic diagnosis of invasive squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma, International Federation of Gynecology and Obstetrics 2009 stage IA1 with positive lymphovascular space invasion (LVSI), stage IA2, or stage IB1 (≤2 cm) with less than two-thirds (<10 mm) cervical stromal invasion.ResultsA total of 44 patients were included in the analysis. The median age was 31 years (range 19–61) and 20 patients (45%) were nulliparous. One patient had a 25 mm tumor while the remaining patients had tumors smaller than 20 mm. Eighteen (41%) patients had LVSI. Median follow-up was 44 months (range 6–137). A total of 17 (39%) patients had negative margins on the diagnostic excisional procedure, and none had residual disease on the repeat cone biopsy. Three (6.8%) patients had micrometastases detected in the SLNs and underwent ipsilateral lymphadenectomy; all remaining non-SLN lymph nodes were negative. Six (13.6%) patients required more definitive surgical or adjuvant treatment due to high-risk pathologic features. There were no recurrences documented. Three patients developed cervical stenosis. The live birth rate was 85% and 16 (94%) of 17 patients had live births at term.ConclusionCervical conization with SLN biopsy appears to be a safe treatment option in selected patients with early cervical cancer. Future results of prospective trials may shed definitive light on fertility-sparing options in this group of patients.

Simple vaginal trachelectomy in women with early-stage low-risk cervical cancer who wish to preserve fertility: the new standard of care?

2020 ◽  
Vol 30 (7) ◽  
pp. 981-986 ◽  
Author(s):  
Marie Plante ◽  
Marie-Claude Renaud ◽  
Alexandra Sebastianelli ◽  
Jean Gregoire
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Residual Disease ◽  
Early Stage ◽  
Low Risk ◽  
Gadolinium Contrast ◽  
Pelvic Mri ◽  
Pelvic Node Dissection ◽  
Early Stage Cervical Cancer ◽  
Lymph Node Assessment

ObjectiveThere is a trend toward less radical surgery in women with small-volume disease who wish to preserve fertility. The objective of our study was to evaluate the oncologic and obstetrical outcome of simple vaginal trachelectomy and lymph node assessment in patients with low-risk early-stage cervical cancer (<2 cm).MethodsFrom May 2007 to January 2020, 50 patients underwent a simple vaginal trachelectomy/conization with laparoscopic sentinel lymph node mapping±complete pelvic node dissection. Patients underwent loop electrocautery excision (LEEP), cone/cervical biopsies, or simple trachelectomy. A preoperative pelvic MRI with gadolinium contrast was systematically performed in all cases. The size of the lesion was established by review of the LEEP, cone or trachelectomy specimen, MRI, and clinical examination. Data was collected prospectively in a computerized database. Descriptive statistics and the Kaplan–Meier estimate were used for analysis.ResultsThe median age was 29 years (range: 21–44) and 35 (70%) patients were nulliparous. As per FIGO 2009 classification, 11 patients had stage IA1 with lymphovascular space invasion (LVSI), 13 patients had stage IA2, and 26 patients had stage IB1. Twenty-six patients had squamous histology, 20 patients adenocarcinoma, and four patients other histologies. On final pathology, lymph nodes were negative in 46 patients (92%), three patients had isolated tumor cells, and one patient had micrometastasis. Thirty patients (60%) had either no residual disease in the trachelectomy specimen (22) or residual dysplasia only (eight). With a median follow-up of 76 months (range: 1–140), only one local recurrence occurred which was treated initially with chemoradiation. She recurred again locally and underwent a pelvic exenteration: the patient progressed again and died of disease. The 5-year progression-free survival and overall survival was 97.9% and 97.6%, respectively. There were 40 pregnancies: five (12.5%) ended in the first trimester, one (2.5%) in the second trimester, and three (7.5%) were late preterm: all the others (30 or 75%) delivered >36 weeks and one pregnancy is ongoing.ConclusionSimple trachelectomy/conization and lymph node assessment is an oncologically safe fertility-preserving surgery in well-selected patients with low-risk early-stage cervical cancer (<2 cm). Obstetrical outcomes are comparable to the general population.

Radical trachelectomy

2021 ◽  
pp. ijgc-2020-001782
Author(s):  
Blanca Segarra-Vidal ◽  
Jan Persson ◽  
Henrik Falconer
Keyword(s):  
Cervical Cancer ◽  
Multidisciplinary Approach ◽  
Early Stage ◽  
Obstetric Outcomes ◽  
Radical Trachelectomy ◽  
Local Resources ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing ◽  
Early Stage Cervical Cancer ◽  
Prospective Trials

Radical trachelectomy is the ‘cornerstone’ of fertility-sparing surgery in patients with early-stage cervical cancer wishing to preserve fertility. Growing evidence has demonstrated the oncologic safety and subsequent favorable pregnancy outcomes in well-selected cases. In the absence of prospective trials, the decision on the appropriate surgical approach (vaginal, open, or minimally invasive surgery) should be based on local resources and surgeons’ preferences. Radical trachelectomy has the potential to preserve fertility in a large proportion of women with early-stage cervical cancer. However, prematurity and premature rupture of membranes are common obstetric complications after radical trachelectomy for cervical cancer. A multidisciplinary approach is crucial to optimize the balance between oncologic and obstetric outcomes. The purpose of this review is to provide an updated overview of the technical, oncologic, and obstetric aspects of radical trachelectomy.

Early-Stage Cervical Cancer

2021 ◽  
pp. 139-157
Author(s):  
Maria Luisa Fais ◽  
Giorgio Candotti ◽  
Giulia Carboni ◽  
Speranza Luisa Anedda ◽  
Valerio Mais ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Reproductive Potential ◽  
Conservative Surgery ◽  
High Resource ◽  
Incidence And Mortality ◽  
Fertility Sparing ◽  
Early Stage Cervical Cancer ◽  
Lymph Node Assessment

Recent advances in screening and early diagnosis have decreased cervical cancer incidence and mortality rate in high-resource settings. The postponement of childbearing and the young age of women at diagnosis produced new challenges in the management of this disease. In recent years, attention has been directed to assessing more conservative procedures that can reduce treatment-related morbidity, without compromising oncologic safety and reproductive potential. Fertility sparing surgery (FSS) procedures, including cervical conization, simple or radical trachelectomy with pelvic nodes dissection or sentinel lymph node assessment, and neoadjuvant chemotherapy followed by conization, have shown encouraging results. In this chapter, the authors discuss the role of conservative surgery in the management of early-stage cervical cancer focusing on obstetrical and oncological outcomes.

Oncologic and obstetric outcomes after simple conization for fertility-sparing surgery in FIGO 2018 stage IB1 cervical cancer

2021 ◽  
Vol 31 (3) ◽  
pp. 452-456
Author(s):  
Francesco Fanfani ◽  
Luigi Pedone Anchora ◽  
Giampaolo Di Martino ◽  
Nicolò Bizzarri ◽  
Maria Letizia Di Meo ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Nodes ◽  
Early Stage ◽  
Fetal Loss ◽  
Disease Free Survival ◽  
Figo Stage ◽  
Oncologic Outcomes ◽  
Obstetric Outcomes ◽  
Gynecology And Obstetrics ◽  
Fertility Sparing

ObjectiveConization/simple trachelectomy is feasible in patients with early-stage cervical cancer. Retrospective data suggest that conization with negative lymph nodes could be a safe option for these patients. This study aims to provide oncologic and obstetric outcomes of a large series of patients with 2018 International Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical cancer managed by conization.MethodsPatients with early cervical cancer and a desire to preserve fertility who underwent conization and pelvic lymphadenectomy from January 1993 to December 2019 in two Italian centers were included. Inclusion criteria were: age >18 years and ≤45 years, 2018 FIGO stage IB1, no prior irradiation or chemotherapy, absence of pre-operative radiologic evidence of nodal metastases, a strong desire to preserve fertility, and absence of concomitant malignancies. We excluded patients with confirmed infertility, neuroendocrine tumor, clear cell or mucinous carcinoma.ResultsA total of 42 patients were included. The median age was 32 years (range 19–44) and median tumor size was 11 mm (range 8–20). Squamous cell carcinoma was found in 27 (64.3%). Grade 3 tumor was present in 7 (16.7%) patients and lymphovascular space involvement was detected in 15 (35.7%). At a median follow-up of 54 months (range 1–185), all patients were alive without evidence of disease. In the entire series three patients experienced recurrence resulting in an overall recurrence rate of 7.1%. All the recurrences occurred in the pelvis (2 in the cervix and 1 in the lymph nodes), resulting in a 3-year disease-free survival of 91.6%. Twenty-two (52%) patients tried to conceive; 18 pregnancies occurred in 17 patients and 12 live births were reported (6 pre-term and 6 term pregnancies). Two miscarriages were recorded, one first trimester and one second trimester fetal loss.ConclusionsOur study showed that conization is feasible for the conservative management of women with stage IB1 cervical cancer desiring fertility. Oncologic outcomes appear favorable in this series of patients. Future prospective studies will hopefully provide further insight into this important question.

scholarly journals Cervical Conization and Sentinel Lymph Node Mapping in the Treatment of Stage I Cervical Cancer: Is Less Enough?

2014 ◽  
Vol 24 (1) ◽  
pp. 113-117 ◽  
Author(s):  
Vaagn Andikyan ◽  
Fady Khoury-Collado ◽  
John Denesopolis ◽  
Kay J. Park ◽  
Yaser R. Hussein ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Cell Carcinoma ◽  
Invasive Carcinoma ◽  
Stage I ◽  
Histologic Diagnosis ◽  
Fertility Sparing ◽  
Cervical Conization

ObjectivesThis study aimed to determine the feasibility of cervical conization and sentinel lymph node (SLN) mapping as a fertility-sparing strategy to treat stage I cervical cancer and to estimate the tumor margin status needed to achieve no residual carcinoma in the cervix.MethodsWe identified all patients who desired fertility preservation and underwent SLN mapping with cervical conization for stage I cervical cancer from September 2005 to August 2012. Relevant demographic, clinical, and pathologic information was collected.ResultsTen patients were identified. Median age was 28 years (range, 18–36 years). None of the patients had a grossly visible tumor. The initial diagnosis of invasive carcinoma was made either on a loop electrosurgical excision procedure or cone biopsy. All patients underwent preoperative radiologic evaluation (magnetic resonance imaging and positron emission tomography–computed tomography). None of the patients had evidence of gross tumor or suspicion of lymph node metastasis on imaging. Stage distribution included 7 (70%) patients with stage IA1 cervical cancer with lymphovascular invasion and 3 (30%) patients with microscopic IB1. Histologic diagnosis included 8 (80%) patients with squamous cell carcinoma, 1 (10%) patient with adenocarcinoma, and 1 (10%) patient with clear cell carcinoma. Nine patients underwent repeat cervical conization with SLN mapping, and 1 patient underwent postconization cervical biopsies and SLN mapping. None of the patients had residual tumor identified on the final specimen. The median distance from the invasive carcinoma to the endocervical margin was 2.25 mm, and the distance from the invasive carcinoma to the ectocervical margin was 1.9 mm. All collected lymph nodes were negative for metastasis. After a median follow-up of 17 months (range, 1–83 months), none of the patients’ conditions were diagnosed with recurrent disease and 3 (30%) patients achieved pregnancy.ConclusionsCervical conization and SLN mapping seems to be an acceptable treatment strategy for selected patients with small-volume stage I cervical cancer. Tumor clearance of 2 mm and above seems to correlate well with no residual on repeat conization. A larger sample size and longer follow-up is needed to establish the long-term outcomes of this procedure.

scholarly journals ConCerv: a prospective trial of conservative surgery for low-risk early-stage cervical cancer

2021 ◽  
Vol 31 (10) ◽  
pp. 1317-1325 ◽  
Author(s):  
Kathleen M Schmeler ◽  
Rene Pareja ◽  
Aldo Lopez Blanco ◽  
Jose Humberto Fregnani ◽  
Andre Lopes ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Early Stage ◽  
Conservative Surgery ◽  
Pelvic Lymph Node Dissection ◽  
Low Risk ◽  
Pelvic Lymph Node ◽  
Node Dissection ◽  
Second Surgery ◽  
Lymph Node Assessment

ObjectiveThe objective of the ConCerv Trial was to prospectively evaluate the feasibility of conservative surgery in women with early-stage, low-risk cervical cancer.MethodsFrom April 2010 to March 2019, a prospective, single-arm, multicenter study evaluated conservative surgery in participants from 16 sites in nine countries. Eligibility criteria included: (1) FIGO 2009 stage IA2–IB1 cervical carcinoma; (2) squamous cell (any grade) or adenocarcinoma (grade 1 or 2 only) histology; (3) tumor size <2 cm; (4) no lymphovascular space invasion; (5) depth of invasion <10 mm; (6) negative imaging for metastatic disease; and (7) negative conization margins. Cervical conization was performed to determine eligibility, with one repeat cone permitted. Eligible women desiring fertility preservation underwent a second surgery with pelvic lymph node assessment, consisting of sentinel lymph node biopsy and/or full pelvic lymph node dissection. Those not desiring fertility preservation underwent simple hysterectomy with lymph node assessment. Women who had undergone an ‘inadvertent’ simple hysterectomy with an unexpected post-operative diagnosis of cancer were also eligible if they met the above inclusion criteria and underwent a second surgery with pelvic lymph node dissection only.Results100 evaluable patients were enrolled. Median age at surgery was 38 years (range 23–67). Stage was IA2 (33%) and IB1 (67%). Surgery included conization followed by lymph node assessment in 44 women, conization followed by simple hysterectomy with lymph node assessment in 40 women, and inadvertent simple hysterectomy followed by lymph node dissection in 16 women. Positive lymph nodes were noted in 5 patients (5%). Residual disease in the post-conization hysterectomy specimen was noted in 1/40 patients—that is, an immediate failure rate of 2.5%. Median follow-up was 36.3 months (range 0.0–68.3). Three patients developed recurrent disease within 2 years of surgery—that is, a cumulative incidence of 3.5% (95% CI 0.9% to 9.0%).DiscussionOur prospective data show that select patients with early-stage, low-risk cervical carcinoma may be offered conservative surgery.

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