Fertility-sparing surgery for young women with early-stage cervical cancer

Abstract

Sir, We read with interest Kolomainen and Shepherd’s letter ‘Fertility-sparing surgery for young women with early-stage cervical cancer’,1 but were surprised that the authors suggest that there is a paucity of data relating to abdominal radical trachelectomy. This procedure was originally described in 1997,2 with a series of 91 cases being published in 2006,3 followed by further series from institutions such as the Memorial Sloan–Kettering Cancer Center and the MD Anderson Cancer Center. Using robotic surgery, patients can be discharged 1 or 2 days after surgery.4 At the West London Gynaecological Cancer Centre (Imperial College London) we offer a range of procedures. For tumours of <2.0 cm in diameter, a vaginal, abdominal or laparoscopic approach may be adopted; however, for tumours of >2.0 cm in diameter an abdominal approach is advised because D’Argent reported a 25% recurrence rate in such cases.5 Abdominal radical trachelectomy is acceptable in almost all cases where a radical hysterectomy would be possible, with the exception of spread to the uterine corpus. We would be interested to know Kolomainen and Shepherd’s approach to women with these tumours (of >2 cm in diameter). We are currently preparing for publication both an international series of 130 cases of abdominal radical trachelectomy with 5 years of completed follow-up, and the Hammersmith Hospital series of 31 cases. We have also reported its use during pregnancy with successful procedures being performed in two out of five cases.6 Abdominal radical trachelectomy has been performed and reported on for more than a decade by multiple institutions from around the world. In our opinion it should be considered a standard option and discussed with all patients with cervical cancer seeking to preserve fertility.