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Clinical Recommendation Radical Trachelectomy for Fertility Preservation in Patients With Early-Stage Cervical Cancer

Schneider, Achim MD, MPH*; Erdemoglu, Evrim MD*†; Chiantera, Vito MD*; Reed, Nicholas MD, BS; Morice, Philippe MD§; Rodolakis, Alexandros MD, PhD; Denschlag, Dominik MD, PhD; Kesic, Vesna MD#

International Journal of Gynecological Cancer:
doi: 10.1097/IGC.0b013e3182466a0e
Cervical Cancer
Abstract

Abstract: Radical trachelectomy (RT) is a fertility-sparing procedure with the aim to provide adequate oncological safety to patients with cervical cancer while preserving their fertility. In the current review, indications, development of the procedure, technical aspects, preoperative and postoperative management, and oncological, fertility, and obstetric outcomes are discussed and studied with respect to whether the procedure is performed abdominally or vaginally. Complications of RT, staging, and more conservative alternatives to RT are discussed as well. A systematic MEDLINE search was performed, which yielded 218 articles, of which 75 were selected for further analysis based on the number of patients and the quality of the study. Strict morphologic criteria should be applied to the candidates to maintain oncological safety. When limited to a tumor less than 2 cm in diameter, the overall recurrence rate after vaginal RT is 3% to 6% and the death rate is 2% to 5%. Data on fertility and obstetric outcome are mostly based on the results of patients who underwent vaginal RT. More data are needed to be able to draw the same conclusions for abdominal RT. Fertility seems not to be decreased, but the risk for premature delivery is 2 to 3 times higher compared to women with an intact cervix. In locally advanced cervical tumors with a diameter larger than 2 cm, neoadjuvant chemotherapy followed by RT may be offered after explaining the experimental nature to the patient. In conclusion, RT is an oncologically safe technique in women with early invasive cancer. The rate of term pregnancies still needs improvement. Fertility-preserving treatment of women with tumors larger than 2 cm in diameter can be done by combining neoadjuvant chemotherapy and trachelectomy; however, experience is still limited.

Author Information

*Department of Gynecology and Gynecologic Oncology, Charite University, Berlin, Germany; †Division of Gynecologic Oncology, Department of Obstetrics and Gynecology Suleyman Demirel University, Isparta, Turkey; ‡Beatson Oncology Centre, Gartnavel General Hospital, Scotland, UK; §Institut Gustave Roussy, Villejuif, France; ∥1st Department of Obstetrics & Gynecology, Gynecologic Oncology Unit, Athens University, Greece; ¶Department of Obstetrics and Gynecology, Hochtaunus-Kliniken gGmbH, Bad Homburg, Germany; and #Faculty of Medicine, University of Belgrade; Department of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade, Serbia.

Address correspondence and reprint requests to Achim Schneider, MD, MPH, Department of Gynecology and Gynecologic Oncology, Charite University, Hindenburgdamm 30, Berlin, Germany. E-mail: achim.schneider@charite.de.

Achim Schneider, Nicholas Reed, Philippe Morice, Alexandros Rodolakis, Dominik Denschlag, and Vesna Kesic are members of the Task Force Fertility Preservation in Gynecologic Cancer, European Society of Gynecologic Oncology.

The authors declare that there are no conflicts of interest.

Received November 24, 2011

Accepted December 13, 2011

Copyright © 2012 by IGCS and ESGO