Effect of vaginal radical trachelectomy in treating the early cervical cancer and preserving fertility

Objective:To explore the effects of vaginal radical trachelectomy(VRT) in treating the early cervical cancer and preserving fertility of patients.Methods:Fifty patients with the early cervical cancer were treated with VRT combined with laparoscopic pelvic lymph node resection.Among the patients,2 cases with pelvic lymph node and cervical margin involvement were treated with synchronized chemoradiotherapy.Results:Among 48 patients,all VRT operations were successful,the operation time and peroperative bleeding were(185±35) min and(310±131) ml,respectively.The cervical length and parametrium width of surgical excision were(2.6±0.6) cm and(1.9±0.5) cm,respectively.The number of lymph node excision was(26±10).The patients were followed up for(35±21) months.Six cases recurred during the following up period,the recurrence rate of which was 12.5%.The recurrence median time was 20 months.Three cases in 8 cases with tumor size more than 2 cm recurred,which was significantly higher than that in the patients with tumor size equal to or less than 2 cm(7.5%,P=0.049 7).Three cases with cadenocarcinoma or adenosquamous carcinoma recurred,the recurrence rate of which was higher than that in 7.1% of patients with squamous carcinoma(P=0.0198).During the equaal to or more than 6 months of following-up,35 patients desired to give birth to,13 women conceived 17 times,the pregnant rate of which was 37.1%.Nine women given birth to 10 newborns babies(1 cases conceived 2 times and were normal delivery),the fertility rate of which was 25.7%.Conclusions:VRT combined with laparoscopic pelvic lymph node resection can effectively preserve the fertility of patients with early cervical cancer.The patients with tumor size equal to or less than 2 cm are easy to recur,the indication of VRT should be strictly limited to the patients with tumor size equal to or less than 2 cm.