J Gynecol Oncol.  2019 May;30(3):e34. 10.3802/jgo.2019.30.e34.

Perioperative morbidity of radical trachelectomy with lymphadenectomy in early-stage cervical cancer: a French prospective multicentric cohort

• Balaya V
• Lécuru F
• Magaud L
• Ngô C
• Huchon C
• Bats AS
• Mathevet P

• KMID: 2440505
• DOI: http://doi.org/10.3802/jgo.2019.30.e34

Abstract

OBJECTIVE
The aim of this study was to determine the predictive factors of postoperative morbidity of patients who have undergone a radical trachelectomy (RT) for early-stage cervical cancer and to assess the oncologic outcomes.
METHODS
We retrospectively analysed the data of 2 prospective trials on sentinel node biopsy for cervical cancer (SENTICOL I and II). Patients having a RT for early-stage cervical cancer with negative sentinel lymph node and safe margins, were included.
RESULTS
Forty-nine patients met the inclusion criteria. Forty-five patients had a laparoscopic-assisted vaginal technique and 4 patients a total laparoscopic technique. The median age was 32 years (range, 22-46 years). 83.7% of patients had a stage IB1 disease. There were 63.3% squamous cell carcinomas and 34.7% adenocarcinomas. The median follow-up was 46 months (range, 1-85 months). Two patients (3.3%) had a severe postoperative complication (Clavien-Dindo ≥III and/or CTCAE ≥3). The main postoperative complications were urinary (28.6%), lymphovascular (26.5%) and neurologic (14.3%). On a multivariate analysis, postoperative complications were significantly associated with history of pelvic surgery and IB1 International Federation of Gynecology and Obstetrics stage. Inclusion in high surgical skills centers decrease the risk of postoperative complications. During the follow-up, 3 patients (6.1%) had a local recurrence and one patient died from a breast cancer. Between group with complications and group without any complications, overall survival and recurrence-free survival did not significantly differ at 5-year of follow-up.
CONCLUSION
RT has few severe postoperative complications and appears as a safe alternative to spare fertility of young patients. To guarantee best surgical outcomes, patients should be referred to expert center.

Keyword

Cervical Cancer; Trachelectomy; Morbidity

MeSH Terms

Adenocarcinoma
Biopsy
Breast Neoplasms
Carcinoma, Squamous Cell
Cohort Studies*
Fertility
Follow-Up Studies
Gynecology
Humans
Lymph Node Excision*
Lymph Nodes
Multivariate Analysis
Obstetrics
Postoperative Complications
Prospective Studies*
Recurrence
Retrospective Studies
Trachelectomy*
Uterine Cervical Neoplasms*