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Curr Opin Obstet Gynecol. 2006 Feb;18(1):8-13.
Radical trachelectomy with laparoscopic lymphadenectomy: review
of oncologic and obstetrical outcomes.
Burnett AF.
Chief, Division of Gynecologic Oncology, University of Arkansas
for Medical Sciences, Little Rock, Arkansas, USA.
PURPOSE OF REVIEW: Fertility preservation in early cervical
cancer by radical trachelectomy is gaining in acceptance as more
cases are published in the literature. Controversies regarding
technique and patient management are beginning to emerge as the
procedure moves from being a new surgery to a part of standard
of care. RECENT Findings:
As the number of cases reported in the
literature increases, the effectiveness of radical trachelectomy
for treating selected early-stage cancers continues to gain
support. The survival of selected patients appears to be no
different than that of similar patients treated with radical
hysterectomy. Central recurrence in the residual cervix is a
very rare event as long as the specimen has cleared the cancer.
Patient selection criteria have evolved, and a more liberal use
of the procedure is warranted. The effectiveness of
trachelectomy in preserving fertility has now been demonstrated
in series of 50 and 56 pregnancies occurring after the
procedure. These larger series detail pregnancy outcomes and
will be invaluable information to our patients who wish to
maintain their ability to bear children. Subtle differences in
technique between centers may account for different pregnancy
outcomes. As more physicians begin to perform radical
trachelectomy, controlled trials will be necessary to refine the
procedure in order to continue to improve obstetric and
oncologic outcomes. SUMMARY: Radical trachelectomy will continue
to increase in popularity as more physicians become willing to
learn the technique. It should routinely be offered to young
women with early cervix cancer who desire to maintain their
fertility.
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