Fertility-Sparing Surgery in Early-Stage Cervical Cancer: Indications and Applications
Fertility-Sparing Surgery in Early-Stage Cervical Cancer: Indications and Applications
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DOI：
10.6004/jnccn.2010.0107
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发表时间：
2010-12-01
影响因子：
13.4
通讯作者：
Sonoda, Yukio
中科院分区：
文献类型：
--
作者：
Abu-Rustum, Nadeem R.;Sonoda, Yukio
本文描述了采用标准化手术技术进行保留生育功能的根治性宫颈切除术的手术及病理结果，并报告了术后结局的发生率。作者分析了一个前瞻性维护的数据库，该数据库包含所有因计划进行保留生育功能的根治性经腹宫颈切除术而进入手术室的国际妇产科联盟（FIGO）IA1 - IB1期宫颈癌患者。通过宫颈注射进行前哨淋巴结定位。在2001年11月至2010年5月期间，连续98例FIGO IA1 - IB1期宫颈癌患者接受了保留生育功能的根治性宫颈切除术，患者中位年龄为32岁（范围为6 - 45岁）。最常见的组织学类型为腺癌54例（55%）和鳞状细胞癌42例（43%）。38例患者（39%）出现淋巴管浸润。FIGO分期包括10例（10%）为IA1期（伴淋巴管浸润），9例（9%）为IA2期，79例（81%）为IB1期。由于术中发现，仅有15例（15%）需要立即完成根治性子宫切除术。评估的淋巴结中位数为22个（范围为3 - 54个），16例（16%）患者在最终病理检查中盆腔淋巴结呈阳性。最终宫颈切除病理显示44例（45%）无残留病灶，5例（5%）为不典型增生，3例（3%）为原位腺癌。总体而言，27例（27%）患者术后需要进行子宫切除术或辅助性盆腔放疗。在本报告时，有1例（1%）记录的复发是致命的。宫颈腺癌和淋巴管浸润是选择进行根治性宫颈切除术患者的常见特征。大多数患者能够成功接受手术，许多患者无残留浸润性疾病；然而，由于肿瘤学原因，在所有入选病例中近27%将需要进行子宫切除术或术后放化疗。对于淋巴结阳性疾病患者的替代性保留生育功能的辅助治疗方法需要进行研究。（《美国国立综合癌症网络杂志》2010年；8：1435 - 1438）
This article describes the surgical and pathologic findings of fertility-sparing radical trachelectomy using a standardized surgical technique, and reports the rate of posttrachelectomy outcomes. The authors analyzed a prospectively maintained database of all patients with FIGO stage IA1-IB1 cervical cancer admitted to the operating room for planned fertility-sparing radical abdominal trachelectomy. Sentinel node mapping was performed through cervical injection. Between November 2001 and May 2010, 98 consecutive patients with FIGO stage IA1-IB1 cervical cancer and a median age of 32 years (range, 6-45 years) underwent a fertility-sparing radical trachelectomy. The most common histology was adenocarcinoma in 54 patients (55%) and squamous carcinoma in 42 (43%). Lymph-vascular invasion was seen in 38 patients (39%). FIGO stages included IA1 (with lymph-vascular invasion) in 10 patients (10%), IA2 in 9 (9%), and IB1 in 79 (81%). Only 15 (15%) needed immediate completion radical hysterectomy because of intraoperative findings. Median number of nodes evaluated was 22 (range, 3-54), and 16 (16%) patients had positive pelvic nodes on final pathology. Final trachelectomy pathology showed no residual disease in 44 (45%) cases, dysplasia in 5 (5%), and adenocarcinoma in situ in 3 (3%). Overall, 27 (27%) patients needed hysterectomy or adjuvant pelvic radiation postoperatively. One (1%) documented recurrence was fatal at the time of this report. Cervical adenocarcinoma and lymph-vascular invasion are common features of patients selected for radical trachelectomy. Most patients can undergo the operation successfully with many having no residual invasive disease; however, nearly 27% of all selected cases will require hysterectomy or postoperative chemoradiation for oncologic reasons. Investigation into alternative fertility-sparing adjuvant therapy in patients with node-positive disease is needed. (JNCCN 2010;8:1435-1438)