Robova Helena, Rob Lukas, Halaska Michael Jiri, Pluta Marek, Skapa Petr
Department of Obstetrics and Gynecology, 2nd Medical Faculty, Charles University, V Uvalu 84, 150 00, Prague 5, Czech Republic,
Curr Oncol Rep. 2015;17(5):446. doi: 10.1007/s11912-015-0446-0.
The number of patients given neoadjuvant chemotherapy (NAC) followed by fertility-sparing surgery in cervical cancer is still scarce. Only a few centres perform these procedures, and thus, such procedures remain largely in the experimental stage. Patients that do not fulfil the criteria for standard fertility-sparing procedure can be included in studies with NAC followed by fertility-sparing procedure. We must consider that both oncological and pregnancy outcomes are important. Patients with only microscopic disease after NAC are apparently the best candidates for fertility-sparing surgery. Current data are not sufficient to identify the optimal procedure after NAC [abdominal radical trachelectomy (ART) or vaginal radical trachelectomy (VRT) or simple trachelectomy]. Some evidence suggests that pregnancy outcome is better after simple trachelectomy as compared with VRT or ART. Long-term results regarding oncological outcome for this concept are still lacking. Adjuvant chemotherapy in patients with histopathological risk factors (lymphovascular space involvement (LVSI), macroscopic residual disease) would decrease a risk of recurrence.
接受新辅助化疗（NAC）后行保留生育功能手术治疗宫颈癌的患者数量仍然很少。只有少数中心开展此类手术，因此，此类手术在很大程度上仍处于实验阶段。不符合标准保留生育功能手术标准的患者可纳入NAC后行保留生育功能手术的研究。我们必须认识到肿瘤学结局和妊娠结局都很重要。NAC后仅存在微小病灶的患者显然是保留生育功能手术的最佳候选者。目前的数据不足以确定NAC后的最佳手术方式（腹式根治性宫颈切除术（ART）、阴道根治性宫颈切除术（VRT）或单纯宫颈切除术）。一些证据表明，与VRT或ART相比，单纯宫颈切除术后的妊娠结局更好。关于这一概念的肿瘤学结局的长期结果仍然缺乏。对存在组织病理学危险因素（脉管间隙浸润（LVSI）、肉眼残留病灶）的患者进行辅助化疗可降低复发风险。
