Excisional cone as fertility-sparing treatment in early-stage cervical cancer

Fertil Steril. 2011 Mar 1;95(3):1109-12. doi: 10.1016/j.fertnstert.2010.11.010. Epub 2010 Dec 3.

Abstract

Objective: To describe a case series of early-stage cervical cancer patients treated with excisional cone instead of radical trachelectomy as fertility-sparing surgery.

Design: Prospective study.

Setting: University hospital.

Patient(s): Early-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IA2-IB1), age ≤ 45 years, tumor ≤ 20 mm.

Intervention(s): Cold-knife conization and laparoscopic pelvic lymphadenectomy.

Main outcome measure(s): Recurrence and pregnancy rate.

Result(s): There were 17 patients: 4 (23.5%) IA2, 13 (76.5%) IB1; 12 (70.5%) squamous cell carcinoma, 4 (23.5%) adenocarcinoma, and 1 (6%) glassy cell tumor. Four cases (23.5%) involved lymphovascular space invasion. The median number of lymph nodes removed was 18 (range 13-51). None of the patients received neoadjuvant chemotherapy, and two patients (12%) received three courses of adjuvant chemotherapy. No recurrences were observed after a median follow-up of 16 months (range 8-101 months). Two of five patients (40%) attempting to conceive had a spontaneous pregnancy and delivery.

Conclusion(s): In selected and informed patients, conization and laparoscopic pelvic lymphadenectomy seems to be feasible as a fertility-sparing surgical approach.

Publication types

  • Clinical Trial

MeSH terms

  • Adenocarcinoma / drug therapy
  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery
  • Adult
  • Carcinoma, Squamous Cell / drug therapy
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / surgery*
  • Cervix Uteri / pathology
  • Cervix Uteri / surgery*
  • Chemotherapy, Adjuvant
  • Combined Modality Therapy
  • Conization / methods*
  • Early Diagnosis
  • Female
  • Fertility*
  • Follicular Phase
  • Follow-Up Studies
  • Humans
  • Lymph Node Excision
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Pregnancy
  • Pregnancy Rate
  • Uterine Cervical Neoplasms / drug therapy
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / surgery*

Supplementary concepts

  • Glassy cell carcinoma of the cervix