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Analysis of a Continuous Series of 34 Young Patients With Early-Stage Cervical Cancer Selected for a Vaginal Radical Trachelectomy: Should Staging Conization Be Systematically Performed Before This Procedure?

Uzan, Catherine MD, PhD*†; Gouy, Sebastien MD*; Desroque, Delphine MD*; Pomel, Christophe MD, PhD; Duvillard, Pierre MD§; Balleyguier, Corrine MD; Haie-Meder, Christine MD; Morice, Philippe MD, PhD*#

International Journal of Gynecological Cancer:
doi: 10.1097/IGC.0b013e31827ef759
Cervical Cancer
Abstract

Objective: Vaginal radical trachelectomy (VRT) is the most widely evaluated form of conservative management of young patients with early-stage (IB1) cervical cancer. Patients with nodal involvement or a tumor size greater than 2 cm are not eligible for such treatment. The aim of this study is to report the impact of a “staging” conization before VRT.

Methods: This is a retrospective study of 34 patients potentially selected for VRT for a clinical and radiologic cervical tumor less than 2 cm. Among them, 28 underwent finally a VRT (20 of them having a previous conization before this procedure) and 6 patients with macroscopic cervical cancer, confirmed by punch biopsies, “eligible” for VRT (<2 cm) had undergone “staging” conization (without further VRT) to confirm the tumor size and lymphovascular space involvement (LVSI) status.

Results: Six patients having “staging” conization before VRT had finally been deemed contraindications to VRT due to the presence of a histologically confirmed tumor greater than 2 cm and/or associated with multiple foci of LVSI. Among 28 patients who underwent VRT, 1 received adjuvant chemoradiation (this patient recurred and died of disease). Two patients treated with RVT (without postoperative treatment) recurred. Ten pregnancies (9 spontaneous and 1 induced) were observed in 9 patients. Among 4 patients with macroscopic “visible” tumor who do not underwent a “staging” conization before VRT, 2 recurred. Among 11 patients who underwent VRT and having LVSI, 3 recurred.

Conclusions: These results suggest that if a conization is not performed initially, it should then be included among the staging procedures to select patients for VRT.

Author Information

*Department of Gynecologic Surgery, †Unit INSERM U 10-30, Institut Gustave Roussy, Villejuif; ‡Department of Surgery, Centre Jean Perrin, Clermont-Ferrand; Departments of §Pathology, ∥Imaging, ¶Radiation Oncology, Institut Gustave Roussy, Villejuif; and #Université Paris-Sud (Paris XI), Le Kremlin Bicêtre, France.

Address correspondence and reprint requests to Catherine Uzan MD, PhD, Service de Chirurgie Gynécologique, Institut Gustave Roussy, 114 rue Edouard vaillant, 94805 Villejuif Cedex, France. E-mail: catherine.uzan@igr.fr.

The authors declare no conflicts of interest.

Received October 29, 2012

Accepted November 20, 2012

Copyright © 2013 by IGCS and ESGO