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Abdominal Radical Trachelectomy: A Safe and Feasible Option for Fertility Preservation in Developing Countries

Testa, Roberto MD1; Ramirez, Pedro T. MD2; Ferreyra, Héctor MD3; Saadi, José MD1; Franco, Gonzalo MD3; Goldsman, Marcos MD3; Perrotta, Myriam MD1

Journal of Lower Genital Tract Disease: October 2013 - Volume 17 - Issue 4 - p 378–384
doi: 10.1097/LGT.0b013e31827cce89
Original Articles

Objective: This study aimed to report on a series of patients with early-stage cervical cancer who underwent an abdominal radical trachelectomy to preserve their fertility.

Materials and Methods: We performed a retrospective review of all patients who underwent an abdominal radical trachelectomy in 2 centers of gynecologic oncology in Argentina. Data collected included patient’s age, stage, histologic subtype, tumor grade, tumor size, evidence of lymph vascular space invasion, number of lymph nodes removed, perioperative complications, as well as oncologic and obstetrical outcomes.

Results: Thirty patients were selected for radical trachelectomy. Five of these patients were excluded from the study: 3 for compromised margins, 1 for lymph node involvement, and 1 for vesicovaginal space involvement. Twenty-five patients underwent the procedure and were included in this report. Median age was 31 years (range = 22–40 years). Nineteen patients had stage IB1, and 6 patients had stage IA2 cervical cancer. Median tumor size was 1.2 cm (range = 0.4–3.5 cm). Median number of pelvic lymph nodes removed was 21 (range = 11–33). Median surgical time was 240 minutes (range = 210–270 minutes), and median length of hospital stay was 3.5 days (range = 3–5 days). Estimated blood loss was 350 mL (range = 200–700 mL). No intraoperative complications were reported. There were 6 postoperative complications. Three patients (12%) were able to get pregnant spontaneously with 3 live births by cesarean delivery. No recurrences were reported with a median follow-up of 29.6 months.

Conclusions: Abdominal radical trachelectomy with pelvic lymphadenectomy is a feasible procedure and a viable option for women wishing to preserve their fertility in developing countries.

We present a series of 25 abdominal radical trachelectomies; no recurrences and 3 pregnant have been reported; and abdominal radical trachelectomy is a safe and feasible technique in selected cases.

1Department of Gynecologic Oncology, Gynecology Service, Hospital Italiano de Buenos Aires, Escuela de Medicina Instituto Universitario, Buenos Aires, Argentina; 2Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; and 3Department of Gynecologic Oncology, Gynecology Service, Hospital Nacional Universitario de Clínicas, Córdoba, Argentina

Reprint requests to: Myriam Perrotta, MD, Department of Gynecologic Oncology, Gynecology Service, Hospital Italiano de Buenos Aires, Escuela de Medicina Instituto Universitario, Buenos Aires, Argentina. E-mail: myriam.perrotta@hospitalitaliano.org.ar

The authors have declared they have no conflicts of interest.

Copyright © 2013 by the American Society for Colposcopy and Cervical Pathology