Radical Vaginal Trachelectomy

Recently, radical vaginal hysterectomy (RVH) has developed into laparoscopically assisted radical vaginal hysterectomy (LARVH), which is associated with the laparoscopical procedure, and it is applied as radical vaginal trachelectomy and semi-radical vaginal hysterectomy. LARVH is indicated for patients with stage IB1 and IIA1 cervical carcinoma, especially those with a tumor size of less than 2 cm, because the cardinal ligaments cannot be resected widely. Although RVH that is associated with laparoscopic pelvic lymphadenectomy is the most used surgical procedure, radical trachelectomy may be performed either abdominally or vaginally (laparoscopic or robotic). One report found that the pregnancy rate was higher in patients who underwent minimally invasive or radical vaginal trachelectomy than in those who underwent radical abdominal trachelectomy.

Oncological and Obstetric Results After Radical Trachelectomy as the Fertility-Sparing Therapy on Early-Stage (FIGO 2018 Stage IA2-IB3) Cervical Cancer Patients

Purpose To explore the oncological and obstetric results after radical trachelectomy in early-stage cervical cancer. Methods Retrospective analysis of the oncological and obstetric results to 23 patients with early cervical cancer (stage IA2-IB3; International Federation of Gynecology and Obstetrics 2018) accepting radical trachelectomy in The Maternal and Child Health Care Hospital of Guiyang from Oct 2004 to Sep 2018. Results Among those patients with tumor size＞4cm (up to 5cm) three patients who wished to preserve fertility accepted radical trachelectomy after neoadjuvant chemotherapy. 23 patients had cervical tumors of the histological type squamous cell carcinoma (SCC). All of the patients retained reproductive function. The mean time of the follow-up was 112.87±55.75months(36-199months). The median tumor size was 2.00±1.35cm (invisible by eyes-5.00cm). No occurred recurrence in any of the cases. Pregnancy outcomes are described as follows: 17 cases attempted to pregnancy, in which 8 cases (47.06%) conceived 12 times. First-trimester abortion and voluntary abandonment of pregnancy occurred in 4 cases (33.33%) respectively, one among patients who choose to abandon pregnancy being induced at 24 weeks of gestation. Second-trimester abortion occurred in3 cases (25.0%), and the reason for abortion was chorioamnionitis. Premature delivery at 32 weeks occurred once (8.33%). Conclusion Radical trachelectomy is a safe and effective treatment for young women with early-stage cervical cancer. Neoadjuvant chemotherapy and Radical trachelectomy provides the possibility of preserving pregnant ability for patients with cervical tumor＞4cm. However, it is worth further exploration.

Clinical Study of Sentinel Lymph Node Detection Using Photodynamic Eye for Abdominal Radical Trachelectomy

This study aimed to assess the accuracy of predicting pelvic lymph node status using sentinel lymph node (SLN) biopsy with indocyanine green (ICG) and to examine the outcomes of SLN biopsy-guided abdominal radical trachelectomy (ART). Patients with stage IA2–IB2 cervical cancer from January 2009 to January 2021 were included. ICG was injected before ART and SLNs were identified, excised, and assessed intraoperatively using fast-frozen sections. Systemic pelvic lymphadenectomy was subsequently performed. The SLN detection rate, sensitivity, and false-negative rate were determined. Thirty patients desiring fertility preservation were enrolled, of whom 26 successfully completed ART and four underwent radical hysterectomies because of metastatic primary SLNs. Bilateral SLNs were identified in all patients. The sensitivity, false-negative rate, and negative predictive value were 100%, 7.7%, and 92.3%, respectively. Three (12%) patients were lost to follow-up: two relapsed and one died of tumor progression. Of the nine patients who tried to conceive after surgery, four achieved pregnancy and three delivered healthy live infants. In women with early-stage cervical cancer who desired to conserve fertility, SLN mapping with ICG had a very high detection rate, sensitivity, and low false-negative rate. SLN biopsy-guided ART is a feasible and accurate method for assessing pelvic node status.

Outcomes of Trachelectomy vs. Hysterectomy for Early-Stage Cervical Cancer: A Systematic Review and Meta-Analysis

Objective: To provide updated evidence on comparative efficacy for clinical outcomes of radical trachelectomy and radical hysterectomy in patients with early-stage cervical cancer.Methods: A systematic search was conducted in the PubMed, Scopus, Cochrane Database of Systematic Reviews, and Google scholar databases. Studies were done in patients with early-stage cervical cancer that compared the outcomes between radical trachelectomy (RT) and hysterectomy (RH) were considered for inclusion in the review. The outcomes of interest were operative time, the volume of blood loss, need for blood transfusion, any complications, length of hospital stay, risk of recurrence, and survival. The strength of association was presented in the form of pooled relative risk (RR), hazards risk (HR), and weighted mean difference (WMD). Statistical analysis was done using STATA version 16.0.Results: A total of 12 articles were included in the meta-analysis. The majority were retrospective cohort-based studies. Compared to RH, the operative time (in min) was comparatively higher in RT (WMD 23.43, 95% CI: 5.63, 41.24). Patients undergoing RT had blood loss (in ml) similar to those undergoing RT (WMD −81.34, 95% CI: −170.36, 7.68). There were no significant differences in the risk of intra-operative (RR 1.61, 95% CI: 0.49, 5.28) and post-operative complications (RR 1.13, 95% CI: 0.54, 2.40) between the two groups. Patients in the RT group had lesser duration of post-operative hospital stay (in days) (WMD −1.65, 95% CI: −3.22, −0.09). There was no statistically significant difference in the risk of recurrence (HR 1.21, 95% CI: 0.68, 2.18), 5-year overall survival (HR 1.00, 95% CI: 0.99, 1.02), and recurrence-free survival (HR 0.99, 95% CI: 0.96, 1.01) between the two groups.Conclusion: Among the patients with early-stage cervical cancer, RT is similar to RH in safety and clinical outcomes. Future studies with a randomized design and larger sample sizes are needed to further substantiate these findings.