Department of Surgery, Division of Gynecology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Int J Gynecol Cancer. 2012 Sep;22(7):1251-7. doi: 10.1097/IGC.0b013e318263eee2.
Abdominal radical trachelectomy (ART) is a type C resection (uterine vessels ligated at origin from the hypogastric vessels). Questions arise as to whether fertility is maintained after ART, particularly when uterine vessels are sacrificed. We report an international series on ART to describe fertility and oncologic outcomes.
Databases at 3 institutions were queried to identify patients planned for ART from 1999 to 2011. Clinical and demographic data were gathered.
One hundred one patients underwent ART. Mean age was 31 years (range, 19-43 years). Histologic classifications were adenocarcinoma (n = 54), squamous cell carcinoma (n = 40), adenosquamous carcinoma (n = 6), and clear cell carcinoma (n = 1). Twenty patients (20%) required conversion to hysterectomy (10 margins and 10 nodes). Eight patients underwent completion hysterectomy owing to the following: positive margins on final pathology (n = 3), patient's choice (n = 4), or recurrence (n = 1). Postoperatively, 20 patients (20%) received adjuvant chemotherapy and/or radiation (4 final pathology margins and 16 nodes). Four patients (4%) had recurrence and lived 22 to 35 months after diagnosis. Of the 70 women who had neither hysterectomy nor adjuvant therapy, 38 (54%) attempted pregnancy and 28 (74%) achieved pregnancy. Thirty-one pregnancies resulted in 16 (52%) third trimester deliveries. Six patients are currently pregnant with outcomes pending.
These data demonstrate that ART preserves fertility and maintains excellent oncologic outcomes. Most women (74%) attempting pregnancy after ART are able to achieve pregnancy and deliver in the third trimester (52%). Preservation of the uterine vasculature is not necessary for fertility; obstetrical outcomes are similar to those of the historical vaginal radical trachelectomy cohorts.
腹式根治性子宫颈切除术（ART）为 C 型切除术（子宫血管在起源处结扎于腹下血管）。ART 后能否保留生育能力存在疑问，特别是当子宫血管被牺牲时。我们报告了一项关于 ART 的国际系列研究，以描述其生育能力和肿瘤学结果。
通过 3 个机构的数据库查询，确定了 1999 年至 2011 年计划进行 ART 的患者。收集了临床和人口统计学数据。
101 例患者接受了 ART。平均年龄为 31 岁（范围 19-43 岁）。组织学分类为腺癌（n=54）、鳞状细胞癌（n=40）、腺鳞癌（n=6）和透明细胞癌（n=1）。20 例（20%）需要转为子宫切除术（10 例为边缘阳性，10 例为淋巴结阳性）。8 例患者因以下原因接受了根治性子宫切除术：最终病理检查边缘阳性（n=3）、患者选择（n=4）或复发（n=1）。术后，20 例（20%）患者接受了辅助化疗和/或放疗（4 例为最终病理边缘阳性，16 例为淋巴结阳性）。4 例（4%）患者复发，诊断后存活 22-35 个月。在未接受子宫切除术或辅助治疗的 70 名女性中，38 名（54%）尝试妊娠，28 名（74%）成功妊娠。31 次妊娠中有 16 次（52%）分娩于孕晚期。6 名孕妇目前正在妊娠，结果待查。
这些数据表明，ART 可保留生育能力并保持良好的肿瘤学结果。大多数（74%）尝试 ART 后妊娠的女性能够成功妊娠并分娩于孕晚期（52%）。保留子宫血管对于生育能力并非必需；产科结局与阴道根治性子宫颈切除术的历史队列相似。
