Radical trachelectomy: a fertility-sparing option for early invasive cervical cancer.

For the past 15 years gynecological oncologists have been seeking ways to preserve woman's fertility when treating invasive cervical cancer. For some women with small localized invasive cervical cancers, there is now hope for pregnancy after treatment. Many cases of cervical cancer are diagnosed in young woman who wish to preserve their fertility. As more women are delaying childbearing, fertility preservation has become an important consideration. The standard surgical treatment for stage IA2-IB1 cervical cancer is a radical hysterectomy and bilateral pelvic lymphadenectomy. This surgery includes removal of the uterus and cervix, radical resection of the parametrial tissue and upper vagina, and complete pelvic lymphadenectomy. Obviously, the standard treatment does not allow future childbearing. Radical trachelectomy is a fertility-sparing surgical approach developed in France in 1994 by Dr. Daniel Dargent for the treatment of early invasive cervical cancer. Young women wishing to bear children in the future may be candidates for fertility-preservation options. The radical trachelectomy operation has been described and performed abdominally, assisted vaginally by laparoscopy and robotically. In this review we discuss the selection criteria for radical trachelectomy, the various possible techniques for the operation, the oncological and obstetric outcomes, and common complications.

[1]  C. Mathers,et al.  Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008 , 2010, International journal of cancer.

[2]  A. Malpica,et al.  Safety and feasibility of robotic radical trachelectomy in patients with early-stage cervical cancer. , 2010, Gynecologic oncology.

[3]  P. Dottino,et al.  Recent advances in the surgical management of cervical cancer. , 2009, The Mount Sinai journal of medicine, New York.

[4]  R. Tambouret,et al.  Abdominal radical trachelectomy: Success and pitfalls in a general gynecologic oncology practice. , 2009, Gynecologic oncology.

[5]  C. Bandera,et al.  Robotic surgery in gynecologic oncology , 2009, Current opinion in obstetrics & gynecology.

[6]  R. Barakat,et al.  Radical vaginal versus abdominal trachelectomy for stage IB1 cervical cancer: a comparison of surgical and pathologic outcomes. , 2009, Gynecologic oncology.

[7]  J. Persson,et al.  Robot-assisted abdominal laparoscopic radical trachelectomy. , 2008, Gynecologic oncology.

[8]  M. Plante.  Vaginal radical trachelectomy: an update. , 2008, Gynecologic oncology.

[9]  D. Cibula,et al.  Update on abdominal radical trachelectomy. , 2008, Gynecologic oncology.

[10]  Carol L. Brown,et al.  Oncologic outcome of fertility-sparing radical trachelectomy versus radical hysterectomy for stage IB1 cervical carcinoma. , 2008, Gynecologic oncology.

[11]  J. P. Geisler,et al.  Robotically assisted total laparoscopic radical trachelectomy for fertility sparing in stage IB1 adenosarcoma of the cervix. , 2008, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[12]  J. Shepherd,et al.  Fertility preserving surgery for carcinoma of the cervix , 2008, Current opinion in oncology.

[13]  M. Höckel,et al.  New Developments in the Surgical Therapy of Cervical Carcinoma , 2008, Annals of the New York Academy of Sciences.

[14]  P. Ramirez,et al.  Fertility preservation in patients with early cervical cancer: radical trachelectomy. , 2008, Gynecologic oncology.

[15]  S. Nofech-Mozes,et al.  Radical vaginal trachelectomy vs. radical hysterectomy for small early stage cervical cancer: a matched case-control study. , 2008, Gynecologic oncology.

[16]  R. Barakat,et al.  Initial experience with Dargent's operation: the radical vaginal trachelectomy. , 2008, Gynecologic oncology.

[17]  P. Mathevet,et al.  Oncological safety of laparoscopic-assisted vaginal radical trachelectomy (LARVT or Dargent's operation): a comparative study with laparoscopic-assisted vaginal radical hysterectomy (LARVH). , 2007, Gynecologic oncology.

[18]  P. Dursun,et al.  Radical vaginal trachelectomy (Dargent's operation): a critical review of the literature. , 2007, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[19]  L. Ehrlich,et al.  Sentinel lymph nodes in early stage cervical cancer. , 2007, Gynecologic oncology.

[20]  P. Mathevet,et al.  Oncological safety of laparoscopic-assisted vaginal radical trachelectomy (LARVT or Dargent’s operation): A comparative study with laparoscopic-assisted vaginal radical hysterectomy (LARVH) , 2007 .

[21]  A. Covens,et al.  Surgery Insight: radical vaginal trachelectomy as a method of fertility preservation for cervical cancer , 2007, Nature Clinical Practice Oncology.

[22]  D. Levine,et al.  Fertility-sparing radical abdominal trachelectomy for cervical carcinoma: technique and review of the literature. , 2006 .

[23]  P. Hillemanns,et al.  Radical vaginal trachelectomy (RVT) combined with laparoscopic pelvic lymphadenectomy: prospective multicenter study of 100 patients with early cervical cancer. , 2006, Gynecologic oncology.

[24]  U. Menon,et al.  Surgical morbidity associated with radical trachelectomy and radical hysterectomy. , 2006, Gynecologic oncology.

[25]  J. Herod,et al.  Radical vaginal trachelectomy as a fertility‐sparing procedure in women with early‐stage cervical cancer—cumulative pregnancy rate in a series of 123 women , 2006, BJOG : an international journal of obstetrics and gynaecology.

[26]  A. Burnett.  Radical trachelectomy with laparoscopic lymphadenectomy: review of oncologic and obstetrical outcomes , 2006, Current opinion in obstetrics & gynecology.

[27]  L. Massuger,et al.  Pregnancy after radical trachelectomy: a real option? , 2005, Gynecologic oncology.

[28]  M. Plante,et al.  Vaginal radical trachelectomy: an oncologically safe fertility-preserving surgery. An updated series of 72 cases and review of the literature. , 2004, Gynecologic oncology.

[29]  M. Plante,et al.  Pregnancies after radical vaginal trachelectomy for early-stage cervical cancer. , 1998, American journal of obstetrics and gynecology.

[30]  J. Shepherd,et al.  Radical trachelectomy: a way to preserve fertility in the treatment of early cervical cancer , 1998, British journal of obstetrics and gynaecology.