Simple conization and pelvic lymphadenectomy in early-stage cervical cancer: A retrospective analysis and review of the literature.

Abstract

OBJECTIVES:

To evaluate the feasibility of cervical conization and laparoscopic pelvic lymphadenectomy as a fertility-sparing surgery to treat early-stage cervical cancer.

METHODS:

We conducted a retrospective analysis from a prospectively maintained database of patients with stage IA1-IB1 grossly invisible cervical cancers undergoing conization plus laparoscopic lymphadenectomy between January 2014 and July 2019.

RESULTS:

Forty patients were identified. Five patients (12.5%) had stage IA1 with lymphovascular space invasion, 21 (52.5%) had stage IA2, and 14 (35.0%) had stage IB1. All of the patients had tumors <2 cm. Histology included 35 (87.5%) squamous-cell carcinomas, three (7.5%) adenocarcinomas, and two (5.0%) adenosquamous carcinomas. Median duration of the procedure was 105 min (range, 31-219), and the median estimated blood loss was 50 ml (range, 30-200). One patient received abdominal radical trachelectomy due to the presence of positive margin after conization. Three patients developed postoperative cervical stenosis. After a median follow-up of 35 months (range, 8-74), only one patient (2.5%) developed a recurrence in the remaining cervix, and no patients died. Four of 17 patients attempting to conceive had a spontaneous pregnancy: three delivered at term and one was currently pregnant.

CONCLUSION:

Cervical conization and pelvic lymphadenectomy seems to be an acceptable treatment for well-selected patients with low-risk, early-stage cervical cancer who wish to preserve fertility. It offers excellent oncologic outcomes, low perioperative morbidities, and good reproductive results. Further large prospective studies are warranted to prove the effectiveness of this surgery.

• Authors: Xiaoqi Li, Lingfang Xia, Xiaojun Chen, Yi Fu, Xiaohua Wu
• Journal: Gynecologic oncology (Gynecol Oncol) Vol. 158 Issue 2 Pg. 231-235 (08 2020) ISSN: 1095-6859 [Electronic] United States
• PMID: 32518013 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Topics

• Adult
• Conization (methods)
• Feasibility Studies
• Female
• Fertility Preservation (methods)
• Humans
• Lymph Node Excision
• Retrospective Studies
• Uterine Cervical Neoplasms (pathology, surgery)
• Young Adult