Long-term fertility, oncological, and quality-of-life outcomes after trachelectomy in early stage cervical cancer.

PURPOSE

Our aim was to evaluate fertility-sparing surgery of early stage cervical cancer after the introduction of vaginal trachelectomy (VT) and pelvic lymph node dissection (PLND). The objectives were to assess surgical, long-term oncological, fertility, and obstetric outcomes together with self-assessed quality of life (QoL).

METHODS

All women ≤ 40 years diagnosed with early stage cervical cancers IA1-IB1 and ≤ 2 cm treated by VT and PLND between 2000 and 2014 were included. All successful fertility-sparing surgeries were identified. Medical records were reviewed and analyzed for surgical, oncological, fertility, and obstetric outcomes. Postal questionnaires were collected to further evaluate and validate the fertility and obstetric outcomes and QoL was assessed using the QLQ-C30 and QLQ-CX24 instruments.

RESULTS

Thirty-nine patients fulfilled the inclusion criteria, where 28 patients (71.8%) had successful VT performed with preserved fertility according to the oncological guidelines. Mean follow-up after VT was 95.0 months (range 26.5-182.4). There were 2 recurrences (7.1%) registered. All together, 24 pregnancies were identified and 17 children born; 76.5% after gestational week (gw) ≥ 34 + 0 and 23.5% preterm (gw < 34 + 0). The questionnaires revealed an overall high level of self-assessed QoL with global health status scores of 91.7 (median) and physical, role, emotional, cognitive, and social functioning all had median scores of 100 and a low incidence of "symptom experience scores" of urogynecological morbidity, although 38.9% experienced lymphedema.

CONCLUSIONS

Early stage cervical cancers treated by VT and PLND are associated with acceptable long-term oncological outcomes, relatively high rate of successful pregnancies, and a high long-term QoL.