Vaginal Radical Trachelectomy in the Treatment of Cervical Cancer: The Role of Frozen Section

Abstract

Summary: 

Vaginal radical trachelectomy (VRT) is a new, alternative surgical procedure to radical hysterectomy for early stage invasive cervical carcinoma in women who desire to preserve fertility. The specimen includes the cervix, parametria, and the vaginal cuff. This study was designed to determine the indications and the best method for evaluating the resection margins of VRT specimens intraoperatively by frozen-section examination. We reviewed 61 VRT specimens planned between October 1991 and January 2002 in our center. A complementary radical hysterectomy is recommended when the tumor extends to within <5 mm of the margin. Of 61 patients, 56 were eligible (5 excluded; 53 VRT and 3 VRT followed by hysterectomy). Of 56 cases, 17 had no macroscopic or microscopic residual tumor. Of 27 cases with a nonspecific macroscopic lesion, more than one-half had no residual microscopic tumor, and the others had minimally (<1 mm) invasive residual carcinoma. In the remaining two cases with a macroscopic tumor, a longitudinal rather than a transverse frozen section was preferred, because it allowed the evaluation of the distance between the tumor and the endocervical margin. We recommend a frozen section, using a longitudinal section, only in those VRT specimens with a grossly visible lesion.