Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China.
Gynecol Oncol. 2013 Oct;131(1):87-92. doi: 10.1016/j.ygyno.2013.07.079. Epub 2013 Jul 19.
As abdominal radical trachelectomy (ART) has become a favored fertility-sparing procedure, the relative contraindication of a tumor ≥ 2 cm in size has been questioned. The aim of the study was to report the surgical and oncological safety of ART for selected patients with cervical cancer ≥ 2 cm in size.
We conducted a retrospective review of a prospectively maintained database of patients undergoing ART at our institution from 04/2004 to 01/2013. The largest tumor dimension was determined by physical exam, MRI or final pathology. Clinical and pathological data were tabulated. All patients were followed postoperatively.
Of the 133 patients who underwent planned ART, 62 (46.6%) had tumors ≥ 2 cm in size (2-4 cm). Forty-six patients were documented by exam or MRI, while 16 were documented by pathology reports. The mean age was 30.4 years, and 42 patients (67.7%) were nulliparous. Fifty (80.7%) had squamous carcinoma, 7 (11.3%) had adenocarcinoma and 5 (8%) had adenosquamous carcinoma. Due to frozen-section results, 6 patients (9.7%) underwent an immediate hysterectomy. Due to high-risk features on final pathology, 27 patients (43.5%) were treated with adjuvant chemotherapy (n=20) or chemoradiation (n=7). In total, 55 (88.7%) of 62 patients with a tumor ≥ 2 cm in size preserved their fertility potential. Among these patients, 35 underwent ART without further adjuvant treatment. At a median follow-up of 30.2 months, there were no recurrences.
Expanding the ART inclusion criteria to cervical cancers ≥ 2 cm in size allows a fertility-sparing procedure in young women who would have otherwise been denied the option with no apparent compromise in oncological outcome. However, this may result in higher rates of conversion to hysterectomy or the need for adjuvant chemotherapy/or chemoradiation.
随着腹式根治性子宫颈切除术（ART）成为一种受欢迎的保留生育力手术，肿瘤大小≥2cm 的相对禁忌症受到质疑。本研究旨在报告对肿瘤大小≥2cm 的宫颈癌患者行 ART 的手术和肿瘤学安全性。
我们对 2004 年 4 月至 2013 年 1 月在我院行 ART 的患者前瞻性数据库进行了回顾性分析。通过体格检查、MRI 或最终病理确定最大肿瘤直径。统计临床和病理数据。所有患者术后均随访。
在 133 例行计划 ART 的患者中，有 62 例（46.6%）肿瘤大小≥2cm（2-4cm）。46 例通过检查或 MRI 记录，16 例通过病理报告记录。平均年龄为 30.4 岁，42 例（67.7%）为未产妇。50 例（80.7%）为鳞癌，7 例（11.3%）为腺癌，5 例（8%）为腺鳞癌。由于冰冻切片结果，6 例（9.7%）患者行即刻子宫切除术。由于最终病理显示高危特征，27 例（43.5%）患者接受辅助化疗（n=20）或放化疗（n=7）。共有 62 例肿瘤大小≥2cm 的患者中 55 例（88.7%）保留了生育能力。这些患者中有 35 例未行进一步辅助治疗而行 ART。中位随访 30.2 个月，无复发。
将 ART 的纳入标准扩大到肿瘤大小≥2cm 的宫颈癌，可以为年轻女性提供保留生育力的手术，否则这些女性将无法选择这种手术，且肿瘤学结果似乎没有受到影响。然而，这可能会导致更高的子宫切除术转化率或需要辅助化疗/放化疗。
