Department of Gynecology, Obstetrics and Urologic Sciences, “La Sapienza” University, Rome, Italy.
Gynecol Oncol. 2012 Jul;126(1):78-81. doi: 10.1016/j.ygyno.2012.04.004. Epub 2012 Apr 6.
To determine the feasibility and safety of simple extra-fascial trachelectomy plus pelvic lymphadenectomy in young patients affected by early stage cervical cancer.
We have prospectively identified all patients with early-stage cervical cancer (stages IA2-IB1) referred to our department. Inclusion criteria were: age ≤ 38 years, strong desire to maintain fertility, FIGO stage ≤ IB1, tumor size<2 cm, no LVSI, no evidence of nodal metastasis. Surgical technique included two steps: laparoscopic pelvic lymphadenectomy and vaginal simple extrafascial trachelectomy. Patients were followed up for oncological and obstetrical outcomes.
Fourteen patients were enrolled in the study. Median age was 32 years (range 28-37); histotype was squamous in 11/14 (79%) cases and adenocarcinoma in 3/14 cases (21%); FIGO stage was IA2 in 5/14 (36%) patients, IB1 in 9/14 (64%) patients; median tumor size was 17 mm (range 14-19); median operative time was 120 min (range 95-210). No severe intraoperative complications were recorded. Postoperative complications were observed in two patients. No recurrences were detected. One patient died for other disease. Eight patients became pregnant and 3 of them had a term delivery.
Low risk early-cervical cancer patients could be safely treated by simple extrafascial trachelectomy in order to maintain fertility. More studies are needed to better define the role of conservative and ultraconservative surgical approaches (i.e. conization) in this setting, either for fertility purposes or to minimize surgical complications.
确定单纯筋膜外子宫颈切除术加盆腔淋巴结切除术在年轻早期宫颈癌患者中的可行性和安全性。
我们前瞻性地确定了所有被转介到我们科室的早期宫颈癌（IA2-IB1 期）患者。纳入标准为：年龄≤38 岁，强烈希望保持生育能力，FIGO 分期≤IB1，肿瘤大小<2cm，无 LVSI，无淋巴结转移证据。手术技术包括两步：腹腔镜盆腔淋巴结切除术和阴道单纯筋膜外子宫颈切除术。患者接受了肿瘤学和产科结局的随访。
14 名患者入组本研究。中位年龄为 32 岁（范围 28-37）；组织学类型为 14 例中的 11 例（79%）为鳞状细胞癌，3 例（21%）为腺癌；FIGO 分期为 5 例（36%）IA2 期，9 例（64%）IB1 期；中位肿瘤大小为 17mm（范围 14-19）；中位手术时间为 120 分钟（范围 95-210）。未记录到严重的术中并发症。术后并发症发生在两名患者中。未发现复发。一名患者因其他疾病死亡。8 名患者怀孕，其中 3 名足月分娩。
为了保持生育能力，低风险的早期宫颈癌患者可以通过单纯筋膜外子宫颈切除术安全治疗。需要进一步的研究来更好地确定保守和超保守手术方法（如子宫颈锥形切除术）在这种情况下的作用，无论是为了生育目的还是为了最小化手术并发症。
