Is radical trachelectomy a safe alternative to radical hysterectomy for patients with stage IA-B carcinoma of the cervix?

BACKGROUND. The prognosis associated with lymph node negative, early stage carcinoma of the cervix is excellent, with 5-year survival rates greater th an 90%. Radical trachelectomy in combination with pelvic lymph node dissect ion (RVT + LPL) has emerged as an alternative to radical hysterectomy (RH) for these patients who desire preservation of fertility. However, there are limited data to support its efficacy and safety. METHODS. All patient information was collected prospectively and was subseq uently extracted horn the cervical cancer surgery database of the Division of Gynecologic Oncology at the University of Toronto. Patients treated by R VT + LPL for fertility preservation were compared with two groups of patien ts treated by RH. One control group was matched for age, tumor size, histol ogy, depth of invasion, presence of capillary lymphatic space involvement, lymph node metastase, and use of adjuvant radiation. The other control grou p consisted of patients with tumor sizes less than or equal to 2 cm, negati ve pelvic lymph nodes who had not received adjuvant radiation therapy. RESULTS. Thirty of 32 patients treated by RVT + LPL between March 1994 and November 1998 were matched. The only statistically significant difference i n prognostic factors between the patients who underwent RVT + LPL and unmat ched controls (556 patients) was the median depth of invasion in the adenoc arcinomas (2.0 mm vs. 4.0 mm, respectively; P < 0.02). The 2-year actuarial recurrence free survival was 95%, 100%, and 97% for the patients who under went RVT + LPL, matched controls, and unmatched controls, respectively. The actuarial conception rate at 12 months was 37%. CONCLUSIONS. Acknowledging the small numbers and short follow-up, RVT + LPL appears to be similar in efficacy to RH. If longer follow-up with more pat ients confirms the above, this procedure will represent an acceptable alter native to RH for patients with early Stage I carcinoma of the cervix who de sire preservation of fertility. (C) 1999 American Cancer Society.