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Radical vaginal trachelectomy as a fertility‐sparing procedure in women with early‐stage cervical cancer—cumulative pregnancy rate in a series of 123 women
Author(s) -
Shepherd JH,
Spencer C,
Herod J,
Ind TEJ
Publication year - 2006
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2006.00936.x
Subject(s) - medicine , trachelectomy , cervical cancer , obstetrics , pregnancy , fertility , gynecology , population , stage (stratigraphy) , fertility preservation , lymphadenectomy , cervix , cancer , biology , genetics , paleontology , environmental health
Objective To analyse the fertility rates, complications and recurrences in a group of women who have undergone radical vaginal trachelectomy and pelvic lymphadenectomy for early‐stage cervical cancer. Design An observational series. Setting A Gynaecological Oncology Centre. Population One hundred and twenty‐three consecutive women who underwent radical vaginal trachelectomy and pelvic lymphadenectomy for early‐stage cervical cancer. Methods Data were collected prospectively. Main outcome measures Complications, recurrences, pregnancies and live births are presented as percentages of the total population. Fertility is presented as a 5‐year cumulative rate, with women attempting to conceive as the denominator. Results A total of 123 women were followed up for an average of 45 months. Eleven (8.9%) had completion treatment (two radical hysterectomies and nine chemoradiotherapy) at the time of initial treatment. There were three recurrences (2.7%) among the women who did not have completion treatment and two (18.2%) in those who did. There were 6 perioperative and 26 postoperative complications. Sixty‐three women attempted pregnancy. There were 55 pregnancies in 26 women and 28 live births in 19. Three women had continuing pregnancies. The 5‐year cumulative pregnancy rate among women trying to conceive was 52.8%. All but two women were delivered by classical caesarean section and seven (25.0%) babies were born at 31 + 6 weeks or less. Conclusions For selected women with early‐stage cervical cancer, radical vaginal trachelectomy and pelvic lymphadenectomy are fertility‐sparing options, with a low incidence of recurrence and acceptable cumulative conception rates. Complications are few, although there is a high premature labour and miscarriage rate among pregnant women.