Australian and New Zealand Journal of Obstetrics and Gynaecology 2014; 54: 450–452

DOI: 10.1111/ajo.12234

Original Article

Radical Trachelectomy for early stage cervical cancer: The Queensland experience Anders P. FABER-SWENSSON,1,2 Lewis C. PERRIN2,3,4 and James L. NICKLIN2,4,5 1

Obstetrics and Gynaecology, Nambour General Hospital, Nambour, QLD, Australia, 2The University of Queensland, Brisbane, QLD, Australia, 3Gynaecological Oncology, Mater Health Services, Brisbane, Qld, Australia, 4Queensland Centre for Gynaecological Cancer, Brisbane, QLD, Australia and 5Gynaecological Oncology, The Royal Brisbane and Women’s Hospital, Brisbane, Qld, Australia

Background: Radical trachelectomy and pelvic lymph node dissection are an increasingly recognised treatment for early cervical cancer in women wishing to retain their fertility. Aims: To analyse and summarise the outcomes of women having undergone radical trachelectomies at the Queensland Centre for Gynaecological Cancer (QCGC) between June 2000 and June 2012. Methods: Retrospective study of data collected on the QCGC database. Results: 17 women underwent radical trachelectomies, with six subsequently giving birth to a total of seven live term babies, all delivered by caesarean section. There was one-first trimester miscarriage, but no major obstetric complications. There have been no cancer recurrences, deaths or major complications. Conclusions: Radical trachelectomy should be offered as an alternative treatment for women with early stage cervical cancer who wish to preserve their fertility as long as they are aware of the increased risk of infertility and preterm birth. Key words: cancer, cervix, fertility, surgery, trachelectomy.

Cervical cancer is the third most common cancer in women worldwide, resulting in an estimated 275,000 deaths in 2008, 88% of which occurred in developing countries.1 In the same year, there were 778 cases of cervical cancer diagnosed in Australia, making it the 13th most common cancer in Australian women. However, at 51 years, it has the lowest average age at diagnosis of any gynaecological cancer, and 53% of cervical cancers were diagnosed in women under the age of 50.2 Data from the United Kingdom show that almost 30% of new cervical cancers are diagnosed in women under age 35 and that the cervical cancer rate has increased recently in this age group.3 The traditional treatment for early cervical cancer is a radical hysterectomy, which confers a 5-year survival of 90% for women with stage 1b1 disease and 95% for stage 1a2 disease.4 Loss of fertility resulting from cancer treatment has been recognised as a significant cause of morbidity in the form of depression, anxiety, grief and sexual dysfunction in cancer survivors, and over the last

20 years, fertility-sparing surgery for early cervical cancer has become increasingly accepted.5,6 Radical vaginal trachelectomy (RVT) with laparoscopic lymph node dissection as fertility-sparing treatment for early cervical cancer was initially described by Daniel Dargent in the mid 1980s and is also referred to as Dargent’s operation.7 The procedure has become widely adopted and suggested criteria for offering fertility sparing are shown below (Table 1). Since the first report of successful pregnancies in women having this surgery was published in 1998, several case series have shown encouraging oncologic and fertility outcomes.8–10 Radical abdominal trachelectomy (RAT) and pelvic lymph node dissection have also been widely documented and appear to have similar outcomes to the vaginal approach.11 A description of patient selection, surgical technique and follow-up in women undergoing radical abdominal trachelectomy in Australia was recently published.12 Both vaginal and abdominal trachelectomies have been performed at our centres, and the goal of this study was to evaluate the fertility and oncological outcomes for these women.

Correspondence: Dr Anders P. Faber-Swensson, Nambour General Hospital, Nambour, QLD 4560, Australia Email: [email protected]

Materials and Methods

Introduction

Received 9 October 2013; accepted 31 May 2014.

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A retrospective review was undertaken of all women who underwent a RVT or RAT at the Queensland Centre for © 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

The Australian and New Zealand Journal of Obstetrics and Gynaecology

Fertility sparing in cervical cancer

Table 1 Criteria for offering fertility-sparing surgery for cervical cancer 1 2 3 4 5

Desire to preserve fertility No clinical evidence of impaired fertility Stage 1a2 to 1b1 (FIGO stage) Lesion size

Radical trachelectomy for early stage cervical cancer: the Queensland experience.

Radical trachelectomy and pelvic lymph node dissection are an increasingly recognised treatment for early cervical cancer in women wishing to retain t...
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