Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Québec, Canada.
Int J Gynecol Cancer. 2013 Jun;23(5):916-22. doi: 10.1097/IGC.0b013e3182954ddf.
This study aimed to evaluate the feasibility of simple vaginal trachelectomy and node assessment in patients with low-risk early-stage cervical cancer (<2 cm).
From May 2007 to November 2012, 16 women with low-risk small-volume cervical cancer underwent a simple vaginal trachelectomy preceded by laparoscopic sentinel node mapping plus or minus pelvic node dissection. Data were collected prospectively in a computerized database. Descriptive statistics and Kaplan-Meyer estimate were used for analysis.
Patients' median age was 30 years and 12 (75%) were nulliparous. Six had a diagnostic cone, 6 had a loop electrocautery excision procedure, 3 had cervical biopsies, and 1 had polyp excision. All patients underwent a preoperative pelvic magnetic resonance imaging. Four patients had stage IA1 with lymph vascular space invasion (LSVI), 6 IA2, and 6 IB1. Ten (62.5%) had squamous lesions, 7 had adenocarcinoma. LVSI was present in 4 cases, suspicious in 2, and absent in 10. There were 2 surgical complications: a trocar site hematoma and a vaginal laceration. The median OR time was 150 minutes (range, 120-180 minutes) and median blood loss was 50 mL (range, 50-150 mL). On final pathology, lymph nodes were negative in all patients. Thirteen (81%) patients had either no residual disease (6) or residual dysplasia only (7) in the trachelectomy specimen. Margins were negative in all cases. With a median follow-up of 27 months (range, 1-65 months), there have been no recurrences. The recurrence-free survival at 24 months is 100%. Eight patients have conceived: 3 were term deliveries and 4 are ongoing.
Simple trachelectomy and nodes seems to be a safe alternative in well-selected patients with early-stage low-risk cervical cancer. Our data will need to be confirmed in larger series.
本研究旨在评估在低危早期宫颈癌（<2cm）患者中进行单纯阴道宫颈切除术和淋巴结评估的可行性。
2007 年 5 月至 2012 年 11 月，16 例低危小体积宫颈癌患者在腹腔镜前哨淋巴结绘图加或不加盆腔淋巴结清扫术前行单纯阴道宫颈切除术。数据前瞻性地收集在计算机数据库中。采用描述性统计和 Kaplan-Meier 估计进行分析。
患者中位年龄为 30 岁，12 例（75%）为未产妇。6 例有诊断锥切，6 例行环形电切除术，3 例有宫颈活检，1 例有息肉切除术。所有患者均行术前盆腔磁共振成像检查。4 例为 IA1 期伴淋巴血管空间侵犯（LVSI），6 例为 IA2 期，6 例为 IB1 期。10 例（62.5%）为鳞癌，7 例为腺癌。LVSI 存在于 4 例，可疑于 2 例，不存在于 10 例。有 2 例手术并发症：套管部位血肿和阴道撕裂。中位手术时间为 150 分钟（范围 120-180 分钟），中位出血量为 50ml（范围 50-150ml）。最终病理淋巴结均为阴性。13 例（81%）患者的宫颈切除术标本中无残留病变（6 例）或仅有残留发育不良（7 例）。所有病例切缘均为阴性。中位随访 27 个月（范围 1-65 个月），无复发。24 个月无复发生存率为 100%。8 例患者已妊娠：3 例足月分娩，4 例仍在妊娠中。
在精心选择的低危早期宫颈癌患者中，单纯宫颈切除术和淋巴结似乎是一种安全的替代方法。我们的数据需要在更大的系列中得到证实。
