A less radical treatment option to the fertility-sparing radical trachelectomy in patients with stage I cervical cancer
A less radical treatment option to the fertility-sparing radical trachelectomy in patients with stage I cervical cancer
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DOI：
10.1016/j.ygyno.2008.07.021
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发表时间：
2008-11-01
影响因子：
4.7
通讯作者：
Robova, Helena
中科院分区：
文献类型：
--
作者：
Rob, Lukas;Pluta, Marek;Robova, Helena
这两项先导性研究的目的是确定使用非根治性保留生育手术的可行性和安全性：先进行前哨淋巴结识别的腹腔镜淋巴清扫(SLNI)，然后进行大锥体或简单的气管切除术(LAP-I方案)和LAP-III方案，其中包括新辅助化疗(NAC)。LAP-I：40名妇女接受了腹腔镜SLNI、冰冻切片分析和完整的盆腔淋巴清扫，作为治疗的第一步。在最后一次切除结节的组织病理学处理后7天，对阴性结节的患者行大锥体或简单的阴道沙眼切除术。9名女性肿瘤大于20 mm，需要在手术前进行3个周期的NAC治疗。LAP-I：6个冰冻切片呈阳性(15%)。在这些病例中，立即进行了III型Wertheim手术。无假阴性SLN。有一例中心性复发，但在放化疗后，在治疗62个月后没有证据表明该疾病。在32名生殖能力保持不变的女性中，有24人试图怀孕。在这24名妇女中，有17名怀孕(怀孕率为71%)。11名母亲生下了12个孩子(24周生下了我，34周生下了我，36周生下了我，37-39周生下了9个孩子)。LAP-III：纳入9名患者。在这9名患者中，有7名患者保持了生育能力，有3名患者怀孕(1名足月，2名仍在继续)。SLNI提高了保留生育能力的手术的安全性。大锥形或单纯的沙眼切除术联合腹腔镜盆腔淋巴清扫术是一种可行的方法，可以产生高的妊娠率。NAC和保留生育能力的手术是较大肿瘤的一种实验性替代治疗方法。(C)2008 Elsevier Inc.保留所有权利。
The purpose of the two pilot studies was to determine the feasibility and safety of using less-radical fertility-preserving surgery: laparoscopic lymphadenectomy with sentinel lymph node identification (SLNI) followed by a large cone or simple trachelectomy (LAP-I protocol) and the LAP-III protocol, which includes neoadjuvant chemotherapy (NAC).LAP-I: Forty women underwent laparoscopic SLNI, frozen-section analysis, and a complete pelvic lymphadenectomy as the first step of treatment. Seven days after final histopathological processing of dissected nodes, a large cone or simple vaginal trachelectomy was performed in patients with negative nodes. Nine women had a tumor larger than 20 mm, prompting the administration of three cycles of NAC before surgery.LAP-I: Six frozen sections were positive (15%). In these cases, a type III Wertheim was immediately performed. There were no false-negative SLNs. There was one central recurrence, but after chemoradiation therapy, there was no evidence of the disease 62 months post-treatment. Twenty-four of 32 women whose reproductive ability had been maintained tried to conceive. Of these 24 women, 17 became pregnant (71% pregnancy rate). Eleven mothers gave birth to 12 children (I at 24 weeks, I at 34 weeks, I at 36 weeks, and 9 between 37 and 39 weeks). LAP-III: Nine patients were included. In 7 of these 9 women, reproductive ability was maintained, with 3 women becoming pregnant (1 full term and 2 ongoing).SLNI improves safety in fertility-sparing surgery. Large cone or simple trachelectomy combined with laparoscopic pelvic lymphadenectomy can be a feasible method that yields a high, successful pregnancy rate. NAC followed by fertility-sparing surgery is an experimental alternative treatment for larger tumors. (C) 2008 Elsevier Inc. All rights reserved.