Fertility after radical trachelectomy in patients with early stage cervical cancer

Purpose: The purpose of this study was to evaluate a fertility-preserving approach for the treatment of early stage cervical cancer. Patients and Methods: We report a case-series of 12 patients treated by trachelectomy and laparoscopic lymphadenectomy between March 1995 and lune 2000 for early stage cervical cancer. Results: The median age was 30 years (range 25-34). Six women were nulligravidae, eight women were nulliparae. Seven cancers were classified as stage 1B1 (1 with lymphovascular space involvement), two as stage 1A1 (1 with blood vessel involvement, 1 with lymph vessel space involvement), two as stage 1A2, and one as stage 2 B. The median operative time was 271 minutes (195-380). The average number of resected lymph nodes was 20 (8-42) in the pelvis and 11 (4-19) in the paraaortic area. Hospitalization was on average 9 days (5-20). During a median follow-up time of 14 months (1-65) a adenocarcinoma in situ diagnosed 12 months after initial treatment recurred in one patient. Three successful post-treatment pregnancies were observed with Caesarean sections in the 26th, 32nd (gemini) and 37th weeks of pregnancy. One further pregnancy had to be terminated by selected abortion in the 12th week of pregnancy. Conclusion: Radical trachelectomy is a valid surgical approach to preserve fertility in young women with early stage cervical cancer. The long-term effectivity of this surgical approach has yet to be evaluated in a prospective multicenter study.