Laparoscopic-Assisted Vaginal Trachelectomy with Prophylactic Cerclage: A Safe Fertility-Sparing Treatment for Early Stage Cervical Cancer.
Cervical cancer
Conservative management
Fertility preservation
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
10 Dec 2023
10 Dec 2023
Historique:
received:
28
07
2023
accepted:
25
11
2023
medline:
10
12
2023
pubmed:
10
12
2023
entrez:
10
12
2023
Statut:
aheadofprint
Résumé
In recent years fertility-sparing treatments are increasingly developing in patients with early stage cervical cancer. The first laparoscopic time is dedicated to the safe opening of the vesicouterine and rectovaginal spaces until the medial pararectal fossa. Ureters are found and bilateral ureterolysis performed under vision. Colpotomy is then vaginally achieved, and the cervix is closed in a vaginal cuff to avoid tumor spread. Careful dissection of the anterior and posterior septa is carried out until reunification with laparoscopic dissection. Bilateral parametrectomy is performed. Vaginal trachelectomy is finalized with a negative deep margin at the frozen section. In the second laparoscopic time a monofilament polypropylene sling cerclage is bilaterally positioned from posterior to anterior through the broad ligaments and fixed anteriorly on the uterine isthmus to prevent an eventual preterm delivery. Laparoscopic-assisted vaginal trachelectomy is a feasible procedure combining the conservative advantages of the vaginal approach and the oncological safety of laparoscopic spaces dissection with possible good obstetric outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
In recent years fertility-sparing treatments are increasingly developing in patients with early stage cervical cancer.
RESULTS
RESULTS
The first laparoscopic time is dedicated to the safe opening of the vesicouterine and rectovaginal spaces until the medial pararectal fossa. Ureters are found and bilateral ureterolysis performed under vision. Colpotomy is then vaginally achieved, and the cervix is closed in a vaginal cuff to avoid tumor spread. Careful dissection of the anterior and posterior septa is carried out until reunification with laparoscopic dissection. Bilateral parametrectomy is performed. Vaginal trachelectomy is finalized with a negative deep margin at the frozen section. In the second laparoscopic time a monofilament polypropylene sling cerclage is bilaterally positioned from posterior to anterior through the broad ligaments and fixed anteriorly on the uterine isthmus to prevent an eventual preterm delivery.
CONCLUSION
CONCLUSIONS
Laparoscopic-assisted vaginal trachelectomy is a feasible procedure combining the conservative advantages of the vaginal approach and the oncological safety of laparoscopic spaces dissection with possible good obstetric outcomes.
Identifiants
pubmed: 38071714
doi: 10.1245/s10434-023-14737-0
pii: 10.1245/s10434-023-14737-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Agence Nationale de la Recherche
ID : ANR-10-IAHU-02
Informations de copyright
© 2023. Society of Surgical Oncology.
Références
Fanfani F, Pedone Anchora L, Di Martino G, et al. Oncologic and obstetric outcomes after simple conization for fertility-sparing surgery in FIGO 2018 stage IB1 cervical cancer. Int J Gynecol Cancer. 2021;31(3):452–6.
doi: 10.1136/ijgc-2020-001750
pubmed: 33649013
Gabriele V, Lecointre L, Faller E, Akladios C. Type B laparoscopic radical trachelectomy with uterine artery preservation for stage IB1 cervical cancer. J Minim Invasive Gynecol. 2019;26(2):365.
doi: 10.1016/j.jmig.2018.05.006
pubmed: 29793043
Smith ES, Moon AS, O’Hanlon R, et al. Radical trachelectomy for the treatment of early-stage cervical cancer: a systematic review. Obstet Gynecol. 2020;136(3):533–42.
doi: 10.1097/AOG.0000000000003952
pubmed: 32769648
pmcid: 7528402
Morice P, Maulard A, Scherier S, et al. Oncologic results of fertility sparing surgery of cervical cancer: an updated systematic review. Gynecol Oncol. 2022;165(1):169–83.
doi: 10.1016/j.ygyno.2022.01.023
pubmed: 35241291