Laparoscopic radical trachelectomy preserves fertility potential

WASHINGTON – Laparoscopic radical trachelectomy can be performed safely in well-selected patients with early cervical cancer who wish to preserve their fertility.

In a small retrospective analysis of 10 women, potential fertility was preserved in 8 women, Dr. Rene Pareja said at the AAGL Global Congress.

By 12 months, no pregnancies had been achieved, reported Dr. Pareja of the Instituto de Cancerología–Clinica las Américas (IDC) in Medellin, Colombia. However, conception should be possible for those who desire to have a child, he said at the meeting sponsored by AAGL.

Patients in the series were treated from 2009 to 2013. All had stage IB1 disease. In nine women, the lesion was less than 2 cm; in one woman, it was 3 cm. Half of the cancers were squamous, and the other half were adenocarcinomas.

All 10 patients underwent a minimally invasive radical trachelectomy. The mean surgical time was 240 minutes, with an estimated blood loss of 100 cc. There were no transfusions and no conversions to open surgery. One cystotomy was repaired laparoscopically. The mean hospital stay was 2 days.

Surgeons recovered a mean of 16 nodes from each patient (range, 10-24); none of these were positive. Four women had no residual disease. One had a positive endocervical margin on pathology; she underwent a hysterectomy. None of the patients required either chemotherapy or radiation therapy.

In addition to the hysterectomy, there were four postoperative complications: one necrosis of the right uterine cornua, one ureterovaginal fistula, and two lymphocysts.

At a mean follow-up of 12 months, there have been no cancer recurrences. One patient is attempting to conceive, although she has not yet done so.

The extant literature supports Dr. Pareja’s experience of laparoscopic radical trachelectomy. Since 2003, the procedure has been reported in 150 patients. Among these, there have been 38 pregnancies, 13 miscarriages, and 20 live births. Dr. Pareja did not say what percentage of women in these studies were attempting to conceive, however.

Five patients reported in the literature have had recurrent cancer and three have died, although Dr. Pareja did not mention whether these deaths were related to the cancers.

So far, the safety and obstetrical outcomes of his patients compare well with those reported in other forms of cervical cancer surgery. Among the 150 reported cases of laparoscopic radical trachelectomy, the relapse rate was 3.3% and death rate 2.9%. The total pregnancy rate was 25% and the delivery rate 13%.

Among the 1,088 reported cases of vaginal radical trachelectomy, there was a 4% relapse rate and 2.9% death rate. The total pregnancy rate was 24% and the delivery rate 28%.

Among the 485 reported cases of abdominal radical trachelectomy, the relapse rate was 3.8% and the death rate 0.4%. The pregnancy rate was 16% and the delivery rate 11%.

Dr. Pareja had no financial disclosures.

[email protected]

WASHINGTON – Laparoscopic radical trachelectomy can be performed safely in well-selected patients with early cervical cancer who wish to preserve their fertility.

In a small retrospective analysis of 10 women, potential fertility was preserved in 8 women, Dr. Rene Pareja said at the AAGL Global Congress.

By 12 months, no pregnancies had been achieved, reported Dr. Pareja of the Instituto de Cancerología–Clinica las Américas (IDC) in Medellin, Colombia. However, conception should be possible for those who desire to have a child, he said at the meeting sponsored by AAGL.

Patients in the series were treated from 2009 to 2013. All had stage IB1 disease. In nine women, the lesion was less than 2 cm; in one woman, it was 3 cm. Half of the cancers were squamous, and the other half were adenocarcinomas.

All 10 patients underwent a minimally invasive radical trachelectomy. The mean surgical time was 240 minutes, with an estimated blood loss of 100 cc. There were no transfusions and no conversions to open surgery. One cystotomy was repaired laparoscopically. The mean hospital stay was 2 days.

Surgeons recovered a mean of 16 nodes from each patient (range, 10-24); none of these were positive. Four women had no residual disease. One had a positive endocervical margin on pathology; she underwent a hysterectomy. None of the patients required either chemotherapy or radiation therapy.

In addition to the hysterectomy, there were four postoperative complications: one necrosis of the right uterine cornua, one ureterovaginal fistula, and two lymphocysts.

At a mean follow-up of 12 months, there have been no cancer recurrences. One patient is attempting to conceive, although she has not yet done so.

The extant literature supports Dr. Pareja’s experience of laparoscopic radical trachelectomy. Since 2003, the procedure has been reported in 150 patients. Among these, there have been 38 pregnancies, 13 miscarriages, and 20 live births. Dr. Pareja did not say what percentage of women in these studies were attempting to conceive, however.

Five patients reported in the literature have had recurrent cancer and three have died, although Dr. Pareja did not mention whether these deaths were related to the cancers.

So far, the safety and obstetrical outcomes of his patients compare well with those reported in other forms of cervical cancer surgery. Among the 150 reported cases of laparoscopic radical trachelectomy, the relapse rate was 3.3% and death rate 2.9%. The total pregnancy rate was 25% and the delivery rate 13%.

Among the 1,088 reported cases of vaginal radical trachelectomy, there was a 4% relapse rate and 2.9% death rate. The total pregnancy rate was 24% and the delivery rate 28%.

Among the 485 reported cases of abdominal radical trachelectomy, the relapse rate was 3.8% and the death rate 0.4%. The pregnancy rate was 16% and the delivery rate 11%.

Dr. Pareja had no financial disclosures.

[email protected]

WASHINGTON – Laparoscopic radical trachelectomy can be performed safely in well-selected patients with early cervical cancer who wish to preserve their fertility.

In a small retrospective analysis of 10 women, potential fertility was preserved in 8 women, Dr. Rene Pareja said at the AAGL Global Congress.

By 12 months, no pregnancies had been achieved, reported Dr. Pareja of the Instituto de Cancerología–Clinica las Américas (IDC) in Medellin, Colombia. However, conception should be possible for those who desire to have a child, he said at the meeting sponsored by AAGL.

Patients in the series were treated from 2009 to 2013. All had stage IB1 disease. In nine women, the lesion was less than 2 cm; in one woman, it was 3 cm. Half of the cancers were squamous, and the other half were adenocarcinomas.

All 10 patients underwent a minimally invasive radical trachelectomy. The mean surgical time was 240 minutes, with an estimated blood loss of 100 cc. There were no transfusions and no conversions to open surgery. One cystotomy was repaired laparoscopically. The mean hospital stay was 2 days.

Surgeons recovered a mean of 16 nodes from each patient (range, 10-24); none of these were positive. Four women had no residual disease. One had a positive endocervical margin on pathology; she underwent a hysterectomy. None of the patients required either chemotherapy or radiation therapy.

In addition to the hysterectomy, there were four postoperative complications: one necrosis of the right uterine cornua, one ureterovaginal fistula, and two lymphocysts.

At a mean follow-up of 12 months, there have been no cancer recurrences. One patient is attempting to conceive, although she has not yet done so.

The extant literature supports Dr. Pareja’s experience of laparoscopic radical trachelectomy. Since 2003, the procedure has been reported in 150 patients. Among these, there have been 38 pregnancies, 13 miscarriages, and 20 live births. Dr. Pareja did not say what percentage of women in these studies were attempting to conceive, however.

Five patients reported in the literature have had recurrent cancer and three have died, although Dr. Pareja did not mention whether these deaths were related to the cancers.

So far, the safety and obstetrical outcomes of his patients compare well with those reported in other forms of cervical cancer surgery. Among the 150 reported cases of laparoscopic radical trachelectomy, the relapse rate was 3.3% and death rate 2.9%. The total pregnancy rate was 25% and the delivery rate 13%.

Among the 1,088 reported cases of vaginal radical trachelectomy, there was a 4% relapse rate and 2.9% death rate. The total pregnancy rate was 24% and the delivery rate 28%.

Among the 485 reported cases of abdominal radical trachelectomy, the relapse rate was 3.8% and the death rate 0.4%. The pregnancy rate was 16% and the delivery rate 11%.

Dr. Pareja had no financial disclosures.

[email protected]