Expanding the indications for radical trachelectomy: a report on 29 patients with stage IB1 tumors measuring 2 to 4 centimeters.
Expanding the indications for radical trachelectomy: a report on 29 patients with stage IB1 tumors measuring 2 to 4 centimeters.
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DOI：
10.1097/igc.0b013e318296034e
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发表时间：
2013-07
期刊：
影响因子：
--
通讯作者：
Abu-Rustum NR
中科院分区：
文献类型：
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作者：
Wethington SL;Sonoda Y;Park KJ;Alektiar KM;Tew WP;Chi DS;Leitao MM Jr;Jewell EL;Barakat RR;Abu-Rustum NR
根治性宫颈切除术使选定的I期宫颈癌女性能够在治疗后保持生育能力。肿瘤大小≥2 cm被认为是禁忌症，这些患者拒绝接受沙眼切除术。我们报告我们的经验，肿瘤测量2-4厘米。我们回顾性分析了所有计划行保留生育能力根治性宫颈切除术患者的病历。通过体格检查、术前MRI或病理学确定最大肿瘤尺寸。无患者接受新辅助化疗。110例患者中有29例（26%）为IB 1期疾病，肿瘤2-4 cm。中位年龄为31岁（范围22-40岁），83%为未经产。鳞状细胞癌13例（45%），腺癌12例（41%），腺鳞癌4例（14%）。29例患者中有13例（45%）盆腔淋巴结阳性。所有主动脉旁淋巴结均为阴性。由于术中冰冻切片，13例（45%）患者接受了立即子宫切除术，1例（3%）接受了明确的放化疗。由于最终病理学的高风险特征，6例（21%）保留子宫的患者接受了放化疗。9例（31%）患者接受了生育保留手术。在中位随访44个月（范围，1-90）时，有1例复发。将根治性宫颈切除术的入选标准扩大到2-4 cm肿瘤的女性，允许30%的患者接受保留生育能力的手术，否则这些患者将被拒绝选择，而不会影响肿瘤学结局。
Radical trachelectomy has enabled select women with stage I cervical cancer to maintain fertility after treatment. Tumor size ≥2 cm has been considered a contraindication and those patients denied trachelectomy. We report our trachelectomy experience with tumors measuring 2–4 cm. We retrospectively reviewed the medical records of all patients planned for fertility-sparing radical trachelectomy. Largest tumor dimension was determined by physical exam, preoperative MRI, or pathology. No patient received neoadjuvant chemotherapy. Twenty-nine of 110 (26%) patients had stage IB1 disease with tumors 2–4 cm. Median age was 31 years (range, 22–40) and 83% were nulliparous. Thirteen (45%) had squamous cell carcinoma, 12 (41%) adenocarcinoma, and 4 (14%) adenosquamous. Thirteen of 29 (45%) patients had positive pelvic nodes. All paraortic nodes were negative. Due to intraoperative frozen section, 13 (45%) patients underwent immediate hysterectomy and 1 (3%) definitive chemoradiation. Due to high-risk features on final pathology, 6 (21%) patients who had retained their uterus received chemoradiation. Nine (31%) patients underwent a fertility-sparing procedure. At median follow-up 44 months (range, 1–90) there was one recurrence. Expanding radical trachelectomy inclusion criteria to women with 2–4 cm tumors allows for a fertility-sparing procedure in 30% of patients who would otherwise have been denied the option, with no compromise in oncologic outcome.