Radical vaginal trachelectomy as a fertility-sparing procedure in women with early-stage cervical cancer - cumulative pregnancy rate in a series of 123 women

Objective To analyse the fertility rates, complications and recurrences in a group of women who,have undergone radical vaginal trachelectomy and pelvic lymphadenectomy for early-stage cervical cancer. Design An observational series. Setting A Gynaecological Oncology Centre. Population One hundred and twenty-three consecutive women who underwent radical vaginal trachelectomy and pelvic lymphadenectomy for early-stage cervical cancer. Methods Data were collected prospectively. Main outcome measures Complications, recurrences, pregnancies and live births are presented as percentages of the total population. Fertility is presented as a 5-year cumulative rate, with women attempting to conceive as the denominator. Results A total of 123 women were followed up for an average of 45 months. Eleven (8.9%) had completion treatment (two radical hysterectomies and nine chemo radiotherapy) at the time of initial treatment. There were three recurrences (2.7%) among the women who did not have completion treatment and two (18.2%) in those who did. There were 6 perioperative and 26 postoperative complications. Sixty-three women attempted pregnancy. There were 55 pregnancies in 26 women and 28 live births in 19. Three women had continuing pregnancies. The 5-year cumulative pregnancy rate among women trying to conceive was 52.8%. All but two women were delivered by classical caesarean section and seven (25.0%) babies were born at 31 + 6 weeks or less. Conclusions For selected women with early-stage cervical cancer, radical vaginal trachelectomy and pelvic lymphadenectomy are fertility-sparing options, with a low incidence of recurrence and acceptable cumulative conception rates. Complications are few, Although there is a high premature labour and miscarriage rate among pregnant women.