Oncologic outcome of fertility-sparing radical trachelectomy versus radical hysterectomy for stage IB1 cervical carcinoma

John P. Diaz, Yukio Sonoda, Mario M. Leitao, Oliver Zivanovic, Carol L. Brown, Dennis S. Chi, Richard R. Barakat, Nadeem R. Abu-Rustum

Research output: Contribution to journalArticle

138 Scopus citations

Abstract

Objective: To compare the oncologic outcomes of women who underwent a fertility-sparing radical trachelectomy (RT) to those who underwent a radical hysterectomy (RH) for stage IB1 cervical carcinoma. Methods: We performed a case-control study of all patients with stage IB1 cervical carcinoma who underwent a vaginal or abdominal RT between 11/01 and 6/07. The control group consisted of patients with stage IB1 disease who underwent an RH between 11/91 and 6/07 and who would be considered candidates for fertility-sparing surgery. Information was extracted from a prospectively acquired database. Recurrence-free and disease-specific survival (RFS and DSS) were estimated using Kaplan-Meier estimates and compared with the log-rank test where indicated. Multivariate analysis was performed using the Cox regression method. Results: Forty stage IB1 patients underwent an RT and 110 patients underwent an RH. There were no statistical differences between the two groups for the following prognostic variables: histology, median number of lymph nodes removed, node positive rate, lymph-vascular space involvement (LVSI), or deep stromal invasion (DSI). The median follow-up for the entire group was 44 months. The 5-year RFS rate was 96% (for the RT group compared to 86% for the RH group (P = NS). On multivariate analysis in this group of stage IB1 lesions, tumor size < 2 cm was not an independent predictor of outcome, but both LVSI and DSI retained independent predictive value (P = 0.033 and 0.005, respectively). Conclusion: For selected patients with stage IB1 cervical cancer, fertility-sparing radical trachelectomy appears to have a similar oncologic outcome to radical hysterectomy. LVSI and DSI appear to be more valuable predictors of outcome than tumor diameter in this subgroup of patients.

Original languageEnglish (US)
Pages (from-to)255-260
Number of pages6
JournalGynecologic oncology
Volume111
Issue number2
DOIs
StatePublished - Nov 1 2008

Keywords

  • Cervical cancer
  • Fertility
  • Fertility-sparing
  • Radical hysterectomy
  • Trachelectomy

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

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    Diaz, J. P., Sonoda, Y., Leitao, M. M., Zivanovic, O., Brown, C. L., Chi, D. S., Barakat, R. R., & Abu-Rustum, N. R. (2008). Oncologic outcome of fertility-sparing radical trachelectomy versus radical hysterectomy for stage IB1 cervical carcinoma. Gynecologic oncology, 111(2), 255-260. https://doi.org/10.1016/j.ygyno.2008.07.014