The vaginal radical trachelectomy: An update of a series of 125 cases and 106 pregnancies
The vaginal radical trachelectomy: An update of a series of 125 cases and 106 pregnancies
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DOI：
10.1016/j.ygyno.2010.12.345
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发表时间：
2011-05-01
影响因子：
4.7
通讯作者：
Roy, Michel
中科院分区：
文献类型：
--
作者：
Plante, Marie;Gregoire, Jean;Roy, Michel
Objective.回顾我们连续进行的125例阴道根治性宫颈电切术（VRT），以评估肿瘤学、生育力和产科结局。方法。我们的前瞻性数据库的数据被用来确定所有的VRT计划在1991年10月至2010年3月之间的早期宫颈癌患者（阶段IA，IB和IIA）。采用卡方检验、Fisher精确检验和Student t检验比较基线特征，绘制Kaplan-Meier生存曲线并与Log-rank检验比较。在研究期间，计划了140例VRT，进行了125例。患者的中位年龄为31岁，75%为未经产。大多数病变为IA 2期（21%）或IB 1期（69%），41%为1级。在组织学方面，56%为鳞状细胞癌，37%为腺癌。29%的病例存在血管间隙侵犯，88.5%的测量2 cm的病变似乎可预测放弃VRT的风险（分别为p = 0.001、p = 0.025和p = 0.03）。肿瘤大小> 2 cm与较高的复发风险具有统计学显著相关性（p = 0.001）。在产科结果方面，58名妇女共怀孕106次。妊娠早期和中期流产率分别为20%和3%，77例（73%）妊娠达到妊娠晚期，其中58例（75%）足月分娩。总体而言，15例（13.5%）患者出现生育问题，其中40%是由于宫颈因素。12例（80%）能够怀孕，其中大多数采用辅助生殖技术。VRT在精心选择的早期疾病患者中是一种肿瘤安全的手术。病变尺寸> 2 cm似乎与较高的复发风险和较高的放弃计划VRT的风险相关。VRT后的生育和产科结局非常好。(C)2010年爱思唯尔公司All rights reserved.
Objective. To review our first consecutive 125 vaginal radical trachelectomies (VRT) to assess the oncologic, fertility and obstetrical outcomes.Methods. Data from our prospective database was used to identify all VRT planned between October 1991 to March 2010 in patients with early-stage cervical cancer (stages IA, IB and IIA). Chi-square test, Fisher's exact test and Student t-test were used to compare baseline characteristics and Kaplan-Meier survival curves were constructed and compared with the use of the log-rank test.Results. During the study period, 140 VRT were planned and 125 were performed. The median age of the patients was 31 and 75% were nulliparous. The majority of the lesions were stage IA2 (21%) or IB1 (69%) and 41% were grade 1. In terms of histology, 56% were squamous and 37% were adenocarcinomas. Vascular space invasion was present in 29% of cases, and 88.5% of the lesions measured 2 cm appeared to be predictive of the risk of abandoning VRT (p = 0.001, p = 0.025 and p = 0.03 respectively). Tumor size > 2 cm was statistically significantly associated with a higher risk of recurrence (p = 0.001). In terms of obstetrical outcome, 58 women conceived a total of 106 pregnancies. The first and second trimester miscarriage rates were 20% and 3% respectively, and 77(73%) of the pregnancies reached the third trimester, of which 58 (75%) delivered at term. Overall, 15 (13.5%) patients experienced fertility problems, 40% of which were due to cervical factor. Twelve (80%) were able to conceive, the majority with assisted reproductive technologies.Conclusion. VRT is an oncologically safe procedure in well-selected patients with early-stage disease. Lesion size > 2 cm appears to be associated with a higher risk of recurrence and a higher risk of abandoning the planned VRT. Fertility and obstetrical outcomes post VRT are excellent. (C) 2010 Elsevier Inc. All rights reserved.