Abdominal radical trachelectomy for invasive cervical cancer: A case series and literature review

Objective: The objective of this study was to review our experience with abdominal radical trachelectomy in patients with early-stage cervical cancer. Methods: We performed a retrospective review of all patients who underwent an abdominal radical trachelectomy at the Instituto de Cancerologia-Clinica las Americas in Medellin, Colombia, between April 2002 and January 2008. Data collected included age, stage, histopathologic subtype, tumor size, evidence of lymph-vascular space invasion, estimated blood loss, number of perioperative blood transfusions, number and disease status of lymph nodes removed, disease status of surgical specimen, length of hospital stay, intraoperative and postoperative complications, follow-up time, and fertility outcomes. Results: Fifteen patients underwent an abdominal radical trachelectomy during the study period. The median patient age was 30 years (range, 25-38). Three patients had stage IA2 and 12 had stage IB1 cervical cancer. Eleven patients had squamous cell carcinoma and 4 had adenocarcinoma. Thirteen patients were diagnosed by cervical conization and 2 by colposcopically directed biopsy. All patients had tumors smaller than 2 cm. The median estimated blood loss was 400 ml (range, 200-1000). The median surgical time was 265 min (range, 210-330). The median number of units of packed red blood cells transfused per patient was 2. The median number of lymph nodes removed was 26 (range, 11-48). The median length of hospitalization was 3 days (range, 2-7). The median follow-up time was 32 months (range, 5-32). There was 1 intraoperative complication and 6 postoperative complications in 4 patients. No patient has had a recurrence. Three patients were able to conceive spontaneously; 1 delivered at 31 weeks' gestation, and 2 delivered at term. Conclusion: Abdominal radical trachelectomy is feasible and can be performed safely in a developing country in well-selected patients with early cervical cancer who wish to preserve their fertility.