Abdominal radical trachelectomy in cervical cancer: a new surgical technique with preservation of the uterine arteries

Abstract

Objectives: To present an abdominal radical trachelectomy surgical technique with complete preservation of the uterine arteries. Design: Clinical and surgical study. Setting: Hospital Oncologico de Buenos Aires Marie Curie, Argentina. Participants: Women with uterine cervical cancer stages Ia2 – Ib1. Interventions: We present a surgical technique designed for fertility sparing in patients with Ia2, Ib1 cervical cancer less than 2 cm (FIGO´s staging). Nine patients 28,5 year-old (20-32) underwent this modified abdominal radical trachelectomy between October 2004 and October 2008. Surgical technique was as follows: 1) Laparotomy with staging, complete and systematic pelvic lymphadenectomy and frozen section of lymph nodes; 2) Dissection of the uterine artery starting at the hypogastric artery; 3) Dissection of the ureter; 4) Transection of the anterior, posterior, and lateral parametria, sparing the hypogastric nerve and plexus; 5) Vaginal cuff opening; 6) Transection of the cervix with frozen biopsy of the superior margin; 7) Suturing of the vagina to the uterine isthmus. Main outcome measures: Age, surgical feasibility, radicality by surgical specimen measurements, blood loss, uterine blood flow by color Doppler ultrasound, operating time, mean hospitalization time, complications, pregnancy, and recurrence. Results: The technique could be performed in all cases. In 2 cases the procedure had to be completed with hysterectomy due to positive margins in the specimen. Blood loss was 600 mL and operating time 180 minutes. Doppler blood flow in endometrium, subendometrium, and uterine arteries was normal. Complications were one case of dyspareunia and cervical polyposis and one case of dysmenorrhea. In the 26 months follow-up (2–38) there was one pregnancy and one central recurrence. Conclusions: This radical trachelectomy variation technique was feasible, with low complication and morbidity rate, and complete preservation of the uterine blood flow, usually considered an essential requirement for implantation in an eventual pregnancy.