Cervical Cancer Patients: Need Not Forgo Fertility

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June 2002 · Vol. 14, No. 6

Surgical Techniques

Cervical Cancer Patients:
Need Not Forgo Fertility

Radical vaginal trachelectomy offers a select group of cervical cancer patients an alternative to traditional radical hysterectomy. The author examines studies that have shown positive oncologic and childbearing outcomes for reproductive-age patients desiring future fertility.

LYNDA ROMAN, MD

Dr. Roman is professor and service chief of gynecologic oncology at the University of Southern California in Los Angeles.

Key Points

Lesions should be smaller than 2 cm to achieve the most favorable outcomes. Masses up to 3 cm can be resected, but the recurrence rate is higher, especially if the tumor has invaded the lymph-vascular space.
Resect the cervix 0.5 to 1 cm distal to the isthmus. If the proximal incision margin has cleared the cancer, close the peritoneum and suture the vaginal mucosa to the cervical stump.
The rate of second-trimester loss is elevated as a result of subclinical chorioamnionitis due to exposure of the membranes to vaginal flora. The Saling procedure has been shown to prevent ascending infections.
The majority of women who have undergone radical vaginal trachelectomy successfully conceive, and most pregnancies result in a live birth.

While the mean age at which cervical cancer is diagnosed is 51, approximately 10% to 15% of women will develop cervical cancer in their reproductive years.¹ Traditionally, early-stage cervical cancers in young women have been treated by radical hysterectomy, resulting in permanent sterility. Now, these patients have an alternative: radical vaginal trachelectomy. This entails the excision of the majority of the cervix and parametria, with preservation of the uppermost portion of the cervix and uterus, allowing the possibility of future childbearing (Figure 1).

The rate of second trimester loss is elevated in radical vaginal trachelectomy patients.

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Cervical Cancer Patients:Need Not Forgo Fertility

Cervical Cancer Patients:
Need Not Forgo Fertility