- 作者：Jin Li ; Xiaohua Wu ; Xiaoqiu Li ; Xingzhu Ju
- 关键词：Abdominal radical trachelectomy (ART) ; Cervical cancer ; Tumor &ge ; ; 2 ; cm ; Oncological outcomes
- 刊名：Gynecologic Oncology
- 出版年：2013
- 出版时间：October, 2013
- 年：2013
- 卷：131
- 期：1
- 页码：87-92
- 全文大小：325 K
Objectives
As abdominal radical trachelectomy (ART) has become a favored fertility-sparing procedure, the relative contraindication of a tumor ¡Ý 2 cm in size has been questioned. The aim of the study was to report the surgical and oncological safety of ART for selected patients with cervical cancer ¡Ý 2 cm in size.Methods
We conducted a retrospective review of a prospectively maintained database of patients undergoing ART at our institution from 04/2004 to 01/2013. The largest tumor dimension was determined by physical exam, MRI or final pathology. Clinical and pathological data were tabulated. All patients were followed postoperatively.
Results
Of the 133 patients who underwent planned ART, 62 (46.6 % ) had tumors ¡Ý 2 cm in size (2-4 cm). Forty-six patients were documented by exam or MRI, while 16 were documented by pathology reports. The mean age was 30.4 years, and 42 patients (67.7 % ) were nulliparous. Fifty (80.7 % ) had squamous carcinoma, 7 (11.3 % ) had adenocarcinoma and 5 (8 % ) had adenosquamous carcinoma. Due to frozen-section results, 6 patients (9.7 % ) underwent an immediate hysterectomy. Due to high-risk features on final pathology, 27 patients (43.5 % ) were treated with adjuvant chemotherapy (n = 20) or chemoradiation (n = 7). In total, 55 (88.7 % ) of 62 patients with a tumor ¡Ý 2 cm in size preserved their fertility potential. Among these patients, 35 underwent ART without further adjuvant treatment. At a median follow-up of 30.2 months, there were no recurrences.
Conclusions
Expanding the ART inclusion criteria to cervical cancers ¡Ý 2 cm in size allows a fertility-sparing procedure in young women who would have otherwise been denied the option with no apparent compromise in oncological outcome. However, this may result in higher rates of conversion to hysterectomy or the need for adjuvant chemotherapy/or chemoradiation.