Radical vaginal trachelectomy as a fertility-sparing procedure in women with early-stage cervical cancer-cumulative pregnancy rate in a series of 123 women

BJOG. 2006 Jun;113(6):719-24. doi: 10.1111/j.1471-0528.2006.00936.x.


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.

MeSH terms

  • Abortion, Spontaneous / etiology
  • Adult
  • Birth Rate
  • Female
  • Follow-Up Studies
  • Humans
  • Lymph Node Excision / methods
  • Middle Aged
  • Neoplasm Recurrence, Local / etiology*
  • Obstetric Labor, Premature / etiology
  • Pregnancy
  • Pregnancy Complications, Neoplastic / etiology*
  • Pregnancy Outcome
  • Pregnancy Rate
  • Prospective Studies
  • Uterine Cervical Neoplasms / surgery*
  • Vagina / surgery*