Radical
trachelectomy is considered standard of care in patients with early-stage
cervical cancer interested in future fertility. The goal of this study was to compare operative, oncologic, and fertility outcomes in patients with early-stage
cervical cancer undergoing open vs. minimally invasive radical
trachelectomy.
METHODS: A total of 100 patients were included in the analysis. Fifty-eight patients underwent open radical
trachelectomy and 42 patients underwent
minimally invasive surgery (MIS=laparoscopic or robotic). There were no differences in patient age, body mass index, race, histology, lymph vascular space invasion, or stage between the two groups. The median
surgical time for MIS was 272min [range, 130-441min] compared with 270min [range, 150-373min] for open surgery (p=0.78). Blood loss was significantly lower for MIS vs.
laparotomy (50mL [range, 10-225mL] vs. 300mL [50-1100mL]) (p<0.0001). Nine patients required
blood transfusion, all in the open surgery group (p=0.010). Length of hospitalization was shorter for MIS than for
laparotomy (1day [1-3 days] vs. 4days [1-9 days]) (p<0.0001). Three
intraoperative complications occurred (3%): 1 bladder injury, and 1 fallopian tube injury requiring unilateral
salpingectomy in the MIS group and 1
vascular injury in the open surgery group. The median lymph node count was 17 (range, 5-47) for MIS vs. 22 (range, 7-48) for open surgery (p=0.03). There were no differences in the rate of postoperative complications (30% MIS vs. 31% open surgery). Among 83 patients who preserved their fertility (33 MIS vs. 50 open surgery), 34 (41%) patients attempted to get pregnant. Sixteen (47%) patients were able to do so (MIS: 2 vs.
laparotomy: 14, p=0.01). The pregnancy rate was higher in the open surgery group when compared to the MIS group (51% vs. 28%, p=0.018). However, median follow-up was shorter is the MIS group compared with the open surgery group (25months [range, 10-69] vs. 66months [range, 11-147]). To date, there has been one recurrence in the
laparotomy group and none in the MIS group.
CONCLUSIONS: