There are an estimated 42,910 new cases of cervical carcinoma in the United States and the European Union annually.1,2 Approximately 28% of all cervical carcinomas are diagnosed in women younger than 40 years of age.3 Women throughout the developed world are postponing childbearing for professional, economic, and other personal reasons. This postponement of childbearing accompanied with the comparatively young age at which many women are diagnosed with cervical carcinoma has posed new challenges in the management of this disease.
The standard surgical management for early-stage cervical carcinoma is a radical abdominal hysterectomy and pelvic (with or without paraaortic) lymph node dissection. This treatment obviously eliminates the possibility of future conception. In recent decades, there has been an increased emphasis on tailoring treatment to provide fertility-sparing options without compromising oncologic outcomes. The radical vaginal trachelectomy with laparoscopic pelvic lymphadenectomy is a fertility-preserving procedure first described in 1994 by Dargent et al.4
Subsequently, numerous investigators have reported their experience with this technique. In addition to the vaginal approach, a fertility-sparing abdominal radical trachelectomy, and a minimally invasive approach have been described in the literature.5,6 These procedures have received widespread acceptance as fertility-sparing surgical options for select patients with early-stage invasive carcinomas of the cervix.7
INDICATIONS AND CLINICAL APPLICATIONS
Appropriate candidates for fertility sparing radical trachelectomy for patients with cervical cancer are those with stages IA1 with lymphovascular invasion, IA2, and IB1 disease. In other words, the tumor should be confined to the cervix without spread to the vagina, parametria, or the lower uterine segment, such that the radical trachelectomy can completely encompass the malignancy with negative surgical margins. Patients who will most likely need postoperative adjuvant whole pelvic radiation therapy following surgery (such as those with suspicious pelvic nodes or possible parametrial invasion) are not ideal candidates for the procedure. There should be no evidence of metastatic disease.
The patient must have a strong desire to preserve her fertility and must be of an age in which future fertility is a reasonable possibility. The procedure has been successfully performed on patients with squamous, adeno, and adenosquamous histologies but is not recommended for small-cell carcinoma or sarcomas due to their overall poor prognosis.
The uterus is a fibromuscular organ. It has 2 portions: an upper muscular corpus and a lower fibrous cervix. The cervix is generally 2 to 4 cm in length and divided into 2 portions: the portio vaginalis, which is the part protruding into the vagina, and the portio supravaginalis, which lies above the vagina and below the corpus. The adnexa is comprised of the fallopian tubes and ovaries. The fallopian tubes are bilateral tubular structures that connect the endometrial cavity to the peritoneal cavity. The ovaries are bilateral, white, flattened oval structures that store ova. The lateral pole ...