FERTILITY

SPARING
ABDOMINAL
RADICAL
TRACHELECTOMY
 Screening programs
early-stage cervical cancer during childbearing age
new challenges in the management of this disease

D.B.J. Dargent, M. Roy, I. Remy Pregnancies following radical trachelectomy for invasive cervical cancer
Gynecol. Oncol., 54 (1994)
J.R. Smith, D.C. Boyle, D.J. Corless, L. Ungar, A.D. Lawson, G. Del Priore et al.Abdominal radical
trachelectomy: a new surgical technique for the conservative management of cervical carcinoma Br. J. Obstet.
Gynaecol., 104 (1997), pp. 1196–1200
N.R. Abu-Rustum, Y. Sonoda, D. Black, D.A. Levine, D.S. Chi, R.R. Barakat Fertility-sparing radical abdominal
trachelectomy for cervical carcinoma: technique and review of the literature Gynecol. Oncol., 103 (2006), pp.
807–813
D. Cibula, J. Slama, D. Fischerova Update on abdominal radical trachelectomy Gynecol. Oncol., 111 (2 Suppl)
(2008), pp. S111–S115
L. Ungar, L. Palfalvi, R. Hogg, P. Siklos, D.C. Boyle, G. Del Preori et al.Abdominal radical trachelectomy: a
fertility-preserving option for woman with early cervical cancer BJOG, 112 (2005), pp. 366–369
F.R. Pareja, P.T. Ramirez, F.M. Borrero, C.G. Angel Abdominal radical trachelectomy for invasive cervical
cancer: a case series and literature review Gynecol. Oncol., 111 (2008), pp. 555–560
E. Aburel Proceedings: extended abdominal extirpation of cervix and isthmus in
early stages of cervix carcinoma (carcinoma in situ and microcarcinoma)
Arch. Gynakol., 214 (1) (1973 (Sep. 28)), pp. 106–108[1]
E. Aburel Colpohysterectomia largita subfundica Panait Scirbu (Ed.), Chirurgia
ginecologicfa: technicfa si tacticfa operatorie, Editura Medicalfa, Bucharest
(1981)
“Although the concept of a uterine fundus-sparing radical abdominal
trachelectomy (Colpohisterectomia largita subfundica) for microcarcinoma
and in situ carcinoma of the cervix was described by Aburel [1] and [6] in
Romania in the 1950s, this abdominal procedure did not initially become
popular; and until recently, fertility-sparing surgical options in cervical cancer
remained limited to cervical conization in selected women with very early
lesions (stage IA1) and a strong desire to retain reproductive function.”
Fertility-sparing radical abdominal trachelectomy for cervical carcinoma:
Technique and review of the literature
Nadeem R. Abu-Rustum,Yukio Sonoda, Destin Black, Douglas A. Levine,
Dennis S. Chi, Richard R. Barakat Gynecol.Oncol 2006, 103:807-13
• J.R. Smith, D.C. Boyle, D.J. Corless, L. Ungar, A.D. Lawson, G. Del Priore
et al.Abdominal radical trachelectomy: a new surgical technique for the
conservative management of cervical carcinoma Br. J. Obstet. Gynaecol.,
104 (1997), pp. 1196–1200

• Standard radicality of parametrial resection

• Possibility of radicality adjustment (II, III, nerve sparing)
• No special training (standard steps of RH)
• Necessity of laparotomy (avoiding by laparoscopy or robotic
surgery)
Parametrium

Paracoplos

Upper vagina
Cervical stump
Very promising
Rate of pregnancy
Rate of first-trimester miscarriage 16%
Rate of second-trimester losses 8%
66-75% reach the third trimester
15% significant prematurity (<32w)
75% > 32w
RT - valuable alternative to young
women
Early stage cervical cancer
Fertility sparing
Oncologic outcome similar to RH
Low complication rate
Good overall obstetrical outcome