Fertility-sparing surgery for early-stage cervical cancer: A case series study on the efficacy and feasibility of cervical conization followed by pelvic lymphadenectomy
Fertility-sparing surgery for early-stage cervical cancer: A case series study on the efficacy and feasibility of cervical conization followed by pelvic lymphadenectomy
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DOI：
10.1111/jog.15215
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发表时间：
2022-03-21
影响因子：
1.6
通讯作者：
Katabuchi，Hidetaka
中科院分区：
文献类型：
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作者：
Yamamoto，Mayuko;Motohara，Takeshi;Katabuchi，Hidetaka
ObjectivesTo evaluate the肿瘤学和产科结局的宫颈锥切术后盆腔淋巴结清扫术，这是一种生育保留程序，在育龄期早期宫颈癌患者中使用。MethodsWe进行了一项回顾性研究，研究对象是2011年至2020年在熊本大学医院接受宫颈锥切术后盆腔淋巴结清扫术的IA 1-IB 1期宫颈癌患者。8例患者接受锥切术后行盆腔淋巴结清扫术。患者的中位年龄为33岁（范围：28-36岁）。4例（50.0%）患者未经产。7例（87.5%）患者被诊断为鳞状细胞癌（87.5%），1例（12.5%）患者被诊断为腺癌。分别有5例（62.5%）、2例（25.0%）和1例（12.5%）出现IA 1、IA 2和IB 1期疾病。5例（62.5%）患者有淋巴血管间隙侵犯（LVSI）的基础上通过锥切标本的评估。盆腔淋巴结清扫后无淋巴结转移。关于长期肿瘤结局，在中位随访60个月（范围：8-107）时未观察到复发。此外，产科结局在实现妊娠、早产和活产方面始终有利。在研究期间，两名积极尝试怀孕的患者有四次怀孕，导致足月分娩，一个是在她的头三个月的pregnancy.ConclusionCervical锥切术结合盆腔淋巴结清扫术是一种可行的保守治疗组织学上精心挑选的早期宫颈癌患者。此外，锥切标本的最佳组织病理学评价将有助于关于使用该生育力保留手术的决策。
ObjectivesTo evaluate the oncologic and obstetric outcomes of cervical conization followed by pelvic lymphadenectomy, which is used as a fertility‐sparing procedure, in reproductive‐aged patients with early‐stage cervical cancer.MethodsWe performed a retrospective study of patients with stage IA1–IB1 cervical cancer who underwent cervical conization followed by pelvic lymphadenectomy from 2011 to 2020 at Kumamoto University Hospital.ResultsIn total, eight patients underwent conization followed by pelvic lymphadenectomy. The median age of the patients was 33 (range: 28–36) years. Four (50.0%) patients were nulliparous. Seven (87.5%) patients were diagnosed with squamous cell carcinoma (87.5%) and one (12.5%) with adenocarcinoma. Five (62.5%), two (25.0%), and one (12.5%) presented with stage IA1, IA2, and IB1 disease, respectively. Five (62.5%) patients had lymphovascular space invasion (LVSI) based on the assessment of specimens obtained via conization. However, none had lymph node metastasis based on pelvic lymphadenectomy. Regarding long‐term oncologic outcomes, recurrence was not observed at a median follow‐up of 60 (range: 8–107) months. In addition, obstetric outcomes were consistently favorable in terms of achieving pregnancy, preterm delivery, and live birth. During the study period, two patients who actively attempted to conceive had four pregnancies, resulting in full‐term deliveries, and one was on her first trimester of pregnancy.ConclusionCervical conization combined with pelvic lymphadenectomy represents a feasible conservative management for histologically well‐selected patients with early‐stage cervical cancer. Furthermore, an optimal histopathological evaluation of conization specimens will contribute to decision‐making regarding the use of this fertility‐sparing procedure.