Department of Gynecology, Asklepios Clinic Altona, Hamburg, Germany
Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree, Berlin, Germny.
Int J Gynecol Cancer. 2024 Jun 3;34(6):799-805. doi: 10.1136/ijgc-2024-005274.
Radical vaginal trachelectomy is a fertility-preserving treatment for patients with early cervical cancer. Despite encouraging oncologic and fertility outcomes, large studies on radical vaginal trachelectomy are lacking.
Demographic, histological, fertility, and follow-up data of consecutive patients who underwent radical vaginal trachelectomy between March 1995 and August 2021 were prospectively recorded and retrospectively analyzed.
A total of 471 patients of median age 33 years (range 21-44) were included. 83% (n=390) were nulliparous women. Indications were International Federation of Gynecology and Oncology (FIGO, 2009) stages IA1 with lymphvascular space involvement (LVSI) in 43 (9%) patients, IA1 multifocal in 8 (2%), IA2 in 92 (20%), IB1 in 321 (68%), and IB2/IIA in 7 (1%) patients, respectively. LVSI was detected in 31% (n=146). Lymph node staging was performed in 151 patients (32%) by the sentinel node technique with a median of 7 (range 2-14) lymph nodes and in 320 (68%) by systematic lymphadenectomy with a median of 19 (range 10-59) lymph nodes harvested. Residual tumor was histologically confirmed in 29% (n=136). In total, 270 patients (62%) were seeking pregnancy of which 196 (73%) succeeded. There were 205 live births with a median fetal weight of 2345 g (range 680-4010 g). Pre-term delivery occurred in 94 pregnancies (46%). After a median follow-up of 159 months (range 2-312), recurrences were detected in 16 patients (3.4%) of which 43% occurred later than 5 years after radical vaginal trachelectomy. Ten patients (2.1%) died of disease (five more than 5 years after radical vaginal trachelectomy). Overall survival, disease-free survival, and cancer-specific survival were 97.5%, 96.2%, and 97.9%, respectively.
Our study confirms oncologic safety of radical vaginal trachelectomy associated with a high chance for childbearing. High rate of pre-term delivery may be due to cervical volume loss. Our long-term oncologic data can serve as a benchmark for future modifications of fertility-sparing surgery.
根治性阴道子宫颈切除术是一种保留生育能力的早期宫颈癌治疗方法。尽管在肿瘤学和生育方面取得了令人鼓舞的结果，但缺乏对根治性阴道子宫颈切除术的大型研究。
前瞻性记录并回顾性分析了 1995 年 3 月至 2021 年 8 月期间连续接受根治性阴道子宫颈切除术的患者的人口统计学、组织学、生育和随访数据。
共纳入 471 例中位年龄 33 岁（范围 21-44）的患者。83%（n=390）为未产妇。适应证为国际妇产科联合会（FIGO，2009）IA1 期伴淋巴管血管间隙浸润（LVSI）43 例（9%），IA1 多发病灶 8 例（2%），IA2 92 例（20%），IB1 321 例（68%），IB2/IIA 7 例（1%）。31%（n=146）检测到 LVSI。151 例（32%）患者采用前哨淋巴结技术进行淋巴结分期，中位数为 7（范围 2-14）个淋巴结，320 例（68%）患者采用系统淋巴结切除术，中位数为 19（范围 10-59）个淋巴结。29%（n=136）的患者组织学证实有残留肿瘤。共有 270 例（62%）患者寻求妊娠，其中 196 例（73%）成功。共有 205 例活产，中位数胎儿体重为 2345g（范围 680-4010g）。早产发生于 94 例妊娠中（46%）。中位随访 159 个月（范围 2-312）后，16 例（3.4%）患者检测到复发，其中 43%的复发发生在根治性阴道子宫颈切除术后 5 年以上。10 例（2.1%）患者死于疾病（5 例发生在根治性阴道子宫颈切除术后 5 年以上）。总生存率、无病生存率和癌症特异性生存率分别为 97.5%、96.2%和 97.9%。
本研究证实了根治性阴道子宫颈切除术的肿瘤安全性，并为生育能力提供了较高的机会。早产率高可能是由于宫颈体积减少所致。我们的长期肿瘤学数据可作为未来生育保留手术改良的基准。
