Radical vaginal trachelectomy: long-term oncologic and fertility outcomes in patients with early cervical cancer

Christhardt Kohler; Andrea Plaikner; Kathrin Siegler; Hermann Hertel; Kati Hasenbein; Anja Petzel; Melanie Schubert; Jens-Uwe Blohmer; Gerd Böhmer; Claudia Stolte; Simone Marnitz; Nina Mallmann-Gottschalk; Peter Oppelt; Giovanni Favero; Silke Westphalen; Ingke Hagemann; Peter Martus; Achim Schneider

doi:10.1136/ijgc-2024-005274

Radical vaginal trachelectomy: long-term oncologic and fertility outcomes in patients with early cervical cancer

Int J Gynecol Cancer. 2024 Apr 10:ijgc-2024-005274. doi: 10.1136/ijgc-2024-005274. Online ahead of print.

Authors

Christhardt Kohler^{1

2}, Andrea Plaikner³, Kathrin Siegler³, Hermann Hertel⁴, Kati Hasenbein⁵, Anja Petzel⁶, Melanie Schubert⁷, Jens-Uwe Blohmer⁸, Gerd Böhmer⁹, Claudia Stolte⁹, Simone Marnitz¹⁰, Nina Mallmann-Gottschalk¹¹, Peter Oppelt¹², Giovanni Favero¹³, Silke Westphalen¹⁴, Ingke Hagemann¹⁵, Peter Martus¹⁶, Achim Schneider²

Affiliations

¹ Department of Gynecology, Asklepios Clinic Altona, Hamburg, Germany ch.koehler@asklepios.com.
² Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree, Berlin, Germny.
³ Department of Gynecology, Asklepios Clinic Altona, Hamburg, Germany.
⁴ Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany.
⁵ Specialized Medical Practice for Gynecologic Oncology, Berlin-Spandau, Berlin, Germany.
⁶ Institute for Dysplasia and Cytology, MVZ Kreuzberg, Berlin, Germany.
⁷ Gynecology and Obstetrics, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.
⁸ Charite Universitatsmedizin Berlin, Berlin, Germany.
⁹ Institute for Dysplasia and Cytology, IZD Hannover, Hannover, Germany.
¹⁰ Radiation Oncology Vosspalais, Private Clinic, Berlin, Germany.
¹¹ Department of Gynecology and Obstetrics, University Hospital of Cologne Medical Faculty, Cologne, Germany.
¹² Department for Gynecology, Obstetrics and Gynecological Endocrinology, Johannes Kepler University Linz, Linz, Austria.
¹³ Department of Gynecology and Obstetrics, Asklepios Hospital Lich, Lich, Germany.
¹⁴ Specialized Medical Practice for Dysplasia and Cytology, Lüneburg, Germany.
¹⁵ Specialized Medical Practice for Dysplasia and Cytology, Kronshagen, Germany.
¹⁶ Institute for Clinical Epidemiology and Biometry, Eberhard Karls University Tübingen Faculty of Medicine, Tubingen, Germany.

PMID: 38599782
DOI: 10.1136/ijgc-2024-005274

Abstract

Objective: Radical vaginal trachelectomy is a fertility-preserving treatment for patients with early cervical cancer. Despite encouraging oncologic and fertility outcomes, large studies on radical vaginal trachelectomy are lacking.

Method: Demographic, histological, fertility, and follow-up data of consecutive patients who underwent radical vaginal trachelectomy between March 1995 and August 2021 were prospectively recorded and retrospectively analyzed.

Results: A total of 471 patients of median age 33 years (range 21-44) were included. 83% (n=390) were nulliparous women. Indications were International Federation of Gynecology and Oncology (FIGO, 2009) stages IA1 with lymphvascular space involvement (LVSI) in 43 (9%) patients, IA1 multifocal in 8 (2%), IA2 in 92 (20%), IB1 in 321 (68%), and IB2/IIA in 7 (1%) patients, respectively. LVSI was detected in 31% (n=146). Lymph node staging was performed in 151 patients (32%) by the sentinel node technique with a median of 7 (range 2-14) lymph nodes and in 320 (68%) by systematic lymphadenectomy with a median of 19 (range 10-59) lymph nodes harvested. Residual tumor was histologically confirmed in 29% (n=136). In total, 270 patients (62%) were seeking pregnancy of which 196 (73%) succeeded. There were 205 live births with a median fetal weight of 2345 g (range 680-4010 g). Pre-term delivery occurred in 94 pregnancies (46%). After a median follow-up of 159 months (range 2-312), recurrences were detected in 16 patients (3.4%) of which 43% occurred later than 5 years after radical vaginal trachelectomy. Ten patients (2.1%) died of disease (five more than 5 years after radical vaginal trachelectomy). Overall survival, disease-free survival, and cancer-specific survival were 97.5%, 96.2%, and 97.9%, respectively.

Conclusion: Our study confirms oncologic safety of radical vaginal trachelectomy associated with a high chance for childbearing. High rate of pre-term delivery may be due to cervical volume loss. Our long-term oncologic data can serve as a benchmark for future modifications of fertility-sparing surgery.

Keywords: Cervical Cancer; Surgery.