RADICAL TRACHELECTOMY

Preserving fertility in early cervical Ca with radical trachelectomy

By Allan Covens, MD

Childbearing is no longer precluded for eligible women with stage IB cervical cancer who undergo this procedure. At some institutions, this alternative has already become standard of care.

A relatively new fertility-preserving procedure is gaining worldwide acceptance as an effective way to surgically manage small invasive cervical cancers. Radical vaginal trachelectomy after laparoscopic pelvic lymphadenectomy involves removing most—or all—of the cervix, its contiguous parametrium, and vaginal cuff, after first removing and examining lymph nodes. In 1994, Dargent first described the procedure in France and then presented his data before the Society of Gynecologic Oncologists.¹ Several other presentations and publications followed.^2-5

The rationale for this procedure is based on the fact that some 15% of all cervical cancers and 45% of surgically treated stage IB cervical cancers occur in women under age 40.⁶ Consequently, a significant proportion of women will not have completed childbearing and could be eligible for a fertility-sparing procedure. Additionally, we can clinically identify a portion of these women who, due to their low likelihood of lymph node spread and recurrence, are unlikely to require postoperative adjuvant therapy and for whom preserving the uterus probably will not compromise survival.