Trachelectomy to preserve fertility is being performed in a growing number of cervical cancer patients, especially those younger than 30, according to new findings.
Survival after the uterus-sparing procedure was similar to survival after radical hysterectomy, but it will be important to continue to follow these patients, said Dr. Jason D. Wright, director of gynecologic oncology at NewYork-Presbyterian/Columbia University Medical Center in New York City and the senior author of the study.
"It’s definitely reassuring, but I would not say it's definitive in that group of women," he told Reuters Health by phone.
Trachelectomy was first performed in 1994, but information on patterns of use and the safety of the procedure are scarce, Dr. Wright and his team note in Obstetrics & Gynecology, online May 7. To investigate, they used the National Cancer Database to look at patients with stage IA2 to IB2 cervical cancer who underwent trachelectomy or hysterectomy between 2004 and 2014.
Among the 15,150 patients included in the study, 97.1% had a hysterectomy and 2.9% had trachelectomy. Overall, trachelectomy use rose from 1.5% in 2004 to 3.8% in 2014. Women under 30 had the largest increase, from 4.6% to 17%.
Trachelectomy was not associated with increased mortality, and five-year survival was 92.4% for hysterectomy and 92.3% for trachelectomy. The findings remained the same when the authors analyzed the results by tumor stage.
Younger women and those who had been diagnosed more recently were more likely to have trachelectomy, while uninsured patients and those covered by Medicaid were less likely to have the procedure.
"Our data suggest that trachelectomy does not adversely affect survival for appropriately selected women with stage I cervical cancer and supports consideration of the procedure in women who desire fertility preservation," Dr. Wright and his team conclude.
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