Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Surgery Insight: radical vaginal trachelectomy as a method of fertility preservation for cervical cancer

Nature Clinical Practice Oncology volume 4, pages 353–361 (2007)Cite this article

Abstract

Over the past decade, the treatment of cervical cancer has evolved with an increased emphasis on preservation of fertility. There has been a gradual abandonment of radical surgical procedures in favor of more conservative techniques in an effort to decrease morbidity and preserve fertility without compromising overall survival. Radical vaginal trachelectomy (RVT) with laparoscopic pelvic lymphadenectomy is a fertility-preserving procedure that has recently gained worldwide acceptance as a method of surgically treating small invasive cancers of the cervix. Since the original description of RVT by Daniel Dargent in 1994, over 500 cases of utilization of this technique have been reported in the literature, with over 100 live births reported following this procedure. The morbidity associated with RVT is low, with a tumor recurrence rate of 5% and a mortality rate of 3%. The current literature indicates no difference in the rate of recurrence with this technique compared with radical hysterectomy when proper selection criteria are used. Combining RVT with laparoscopic sentinel lymph-node biopsy can further reduce the duration, extent, and complications of surgery.

Key Points

  • RVT is a safe and feasible procedure to perform in women with small cervical carcinomas who wish to preserve fertility

  • The tumor recurrence rate is 5% and the mortality rate from disease recurrence is about 3%; these results are comparable to those observed with radical hysterectomy

  • Lesion size >2 cm is probably the most important risk factor in terms of tumor recurrence

  • Pregnancy rates following RVT range between 41% and 79%, and term delivery (≥37 weeks) is reached in 38% of the pregnancies

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Covens A et al. (2001) Changes in the demographics and perioperative care of stage IA(2)/IB(1) cervical cancer over the past 16 years. Gynecol Oncol 81: 133–137

    Article  CAS  Google Scholar 

  2. Mathevet P et al. (2003) Fertility preservation in early cervical cancer [French]. Gynecol Obstet Fertil 31: 706–712

    Article  CAS  Google Scholar 

  3. Burnett AF (2006) Radical trachelectomy with laparoscopic lymphadenectomy: review of oncologic and obstetrical outcomes. Curr Opin Obstet Gynecol 18: 8–13

    Article  Google Scholar 

  4. Plante M et al. (2004) Vaginal radical trachelectomy: an oncologically safe fertility-preserving surgery: an updated series of 72 cases and review of the literature. Gynecol Oncol 94: 614–623

    Article  Google Scholar 

  5. Boss EA et al. (2005) Pregnancy after radical trachelectomy: a real option? Gynecol Oncol 99 (Suppl 1): S152–S156

    Article  CAS  Google Scholar 

  6. Benedetti-Panici P et al. (2000) Early cervical carcinoma: the natural history of lymph node involvement redefined on the basis of thorough parametrectomy and giant section study. Cancer 88: 2267–2274

    Article  CAS  Google Scholar 

  7. Plante M et al. (2006) Neoadjuvant chemotherapy followed by vaginal radical trachelectomy in bulky stage IB1 cervical cancer: case report. Gynecol Oncol 101: 367–370

    Article  Google Scholar 

  8. Schlaerth JB et al. (2003) Radical trachelectomy and pelvic lymphadenectomy with uterine preservation in the treatment of cervical cancer. Am J Obstet Gynecol 188: 29–34

    Article  Google Scholar 

  9. Burnett AF et al. (2003) Radical vaginal trachelectomy and pelvic lymphadenectomy for preservation of fertility in early cervical carcinoma. Gynecol Oncol 88: 419–423

    Article  Google Scholar 

  10. Hertel H et al. (2006) Radical vaginal trachelectomy (RVT) combined with laparoscopic pelvic lymphadenectomy: prospective multicenter study of 100 patients with early cervical cancer. Gynecol Oncol 103: 506–511

    Article  Google Scholar 

  11. Shepherd JH et al. (2006) Radical vaginal trachelectomy as a fertility-sparing procedure in women with early-stage cervical cancer—cumulative pregnancy rate in a series of 123 women. BJOG 113: 719–724

    Article  CAS  Google Scholar 

  12. Covens A (2003) Preserving fertility in early cervical Ca with radical trachelectomy. Contemp Ob Gyn 2: 460–466

    Google Scholar 

  13. Peppercorn PD et al. (1999) Role of MR imaging in the selection of patients with early cervical carcinoma for fertility-preserving surgery: initial experience. Radiology 212: 395–399

    Article  CAS  Google Scholar 

  14. Wagenaar HC et al. (2001) Tumor diameter and volume assessed by magnetic resonance imaging in the prediction of outcome for invasive cervical cancer. Gynecol Oncol 82: 474–482

    Article  CAS  Google Scholar 

  15. Alexander-Sefre F et al. (2006) Surgical morbidity associated with radical trachelectomy and radical hysterectomy. Gynecol Oncol 101: 450–454

    Article  CAS  Google Scholar 

  16. Jackson KS and Naik R (2006) Pelvic floor dysfunction and radical hysterectomy. Int J Gynecol Cancer 16: 354–363

    Article  CAS  Google Scholar 

  17. Covens A et al. (1999) Is radical trachelectomy a safe alternative to radical hysterectomy for patients with stage IA-B carcinoma of the cervix? Cancer 86: 2273–2279

    Article  CAS  Google Scholar 

  18. Bali A et al. (2005) Central pelvic recurrence 7 years after radical vaginal trachelectomy. Gynecol Oncol 96: 854–856

    Article  Google Scholar 

  19. Morice P et al. (2004) First case of a centropelvic recurrence after radical trachelectomy: literature review and implications for the preoperative selection of patients. Gynecol Oncol 92: 1002–1005

    Article  Google Scholar 

  20. Delgado G et al. (1990) Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol 38: 352–357

    Article  CAS  Google Scholar 

  21. Smith HO et al. (2000) The rising incidence of adenocarcinoma relative to squamous cell carcinoma of the uterine cervix in the United States—a 24-year population-based study. Gynecol Oncol 78: 97–105

    Article  CAS  Google Scholar 

  22. Liu S et al. (2001) Cervical cancer: the increasing incidence of adenocarcinoma and adenosquamous carcinoma in younger women. CMAJ 164: 1151–1152

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Plante M et al. (2005) Vaginal radical trachelectomy: a valuable fertility-preserving option in the management of early-stage cervical cancer: a series of 50 pregnancies and review of the literature. Gynecol Oncol 98: 3–10

    Article  Google Scholar 

  24. Klemm P et al. (2005) Does radical trachelectomy influence uterine blood supply? Gynecol Oncol 96: 283–286

    Article  Google Scholar 

  25. Bernardini M et al. (2003) Pregnancy outcomes in patients after radical trachelectomy. Am J Obstet Gynecol 189: 1378–1382

    Article  Google Scholar 

  26. Plante M et al. (2005) Radical vaginal trachelectomy: a fertility-preserving option for young women with early stage cervical cancer. Gynecol Oncol 99 (Suppl 1): S143–S146

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. ME Beiner is a Fellow at the Gynecologic Oncology Division, Head of the Division of Gynecologic Oncology, University of Toronto, and A Covens is Professor of Obstetrics and Gynecology, at Sunnybrook Health Sciences Center, and Fellowship Director for the University of Toronto, Toronto, ON, Canada.,

    Mario E Beiner & Allan Covens

Authors
  1. Mario E Beiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Allan Covens
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Allan Covens.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beiner, M., Covens, A. Surgery Insight: radical vaginal trachelectomy as a method of fertility preservation for cervical cancer. Nat Rev Clin Oncol 4, 353–361 (2007). https://doi.org/10.1038/ncponc0822

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncponc0822

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing