Four Surgical Approaches to Cervical Excision During Laparoscopic Radical Trachelectomy for Early Cervical Cancer

Abstract A retrospective analysis was performed at the Gynecology Department of the Hospital Italiano de Buenos Aires in Buenos Aires, Argentina to compare clinical and oncologic outcomes of four different surgical approaches of cervical excision (CE) during radical trachelectomy (RT) for early cervical cancer. The study included 22 consecutive women who had undergone laparoscopic RT for early cervical cancer between May 2011 and July 2016 in our tertiary care hospital. Patients were divided into four groups according to their respective tumor pathologies and surgical approaches. A total of 5 (22.7%) patients had International Federation of Gynecology and Obstetrics (FIGO) stage IA2, and 17 (77.3%) had FIGO stage IB1. Squamous carcinoma was diagnosed in 17 (77.3) patients. Mean surgical time for all patients was 277.5 (± 47 standard deviation [SD]) minutes with 289.3 (± 36 SD), 265.0 (± 32 SD), 266.7 (± 67 SD), and 2967 (± 60 SD) minutes for type A, B, C, and D CEs, respectively. Mean estimated blood loss was 345.5 (± 88 SD) mL. Mean hospital length of stay was 2.5(± 0.7 SD) days. No intraoperative complications were observed. One patient presented with cervical stenosis and another Asherman’s syndrome, both after type B CE. Only grade 1/2 postoperative complications were noted in 9 patients. One local recurrence after type B CE was treated with radical hysterectomy plus chemoradiation; while another patient relapsed with peritoneal carcinomatosis managed with chemotherapy after type A CE. The different types of cervical excisions should be determined on a case by case basis according to individual tumor factors.