Oncological safety of laparoscopic-assisted vaginal radical trachelectomy (LARVT or Dargent's operation): a comparative study with laparoscopic-assisted vaginal radical hysterectomy (LARVH).

OBJECTIVE: The aim of our study was to compare the results of radical trachelectomy (LARVT or Dargent's operation) to radical vaginal hysterectomy (LARVH) in terms of intraoperative and postoperative morbidity and mainly in terms of risk of tumor recurrence. Each technique is associated with laparoscopic pelvic lymph node dissection. Our objective was to know if performing radical trachelectomy in order to preserve the fertility of a young patient with an early cervical cancer is associated or not with an increased risk of operative morbidity or tumor recurrence.

METHODS: Patient affected by early invasive cervical cancer who has been submitted to LARVT (n=118) in our Institute between December 1986 and December 2003 has been compared to patients treated by LARVH (n=139) in the same period. All patient's information, surgical and pathological data and oncological results have been prospectively collected. The associations between the discrete variables were assessed using chi(2) test with Yate's correction when appropriate. Fisher's exact test was used when it was necessary. Continuous variables were compared by Student's t test. p values less than 0.05 were considered statistically significant. Statistical analysis used the Kaplan-Meier method to calculate disease-free and overall survival.

RESULTS: Between December 1986 and December 2003, 118 and 139 patients have undergone LARVT and LARVH, respectively, for FIGO stage I-IIA carcinoma of the cervix. The two populations (LARVT and LARVH) are comparable in terms of the main prognostic factors of cervical cancer. The rate of intraoperative complications has been similar in the two groups (2.5% for LAVRT and 5.8% for LAVRH, p=NS). Also the rate of postoperative complications has been similar in the two groups (21.2% for LAVRT and 19.4% for LAVRH, p=NS). When considering the risk of recurrence, the results in the two groups are also identical: 7 cases (5.2%) in patients treated with LAVRT and 9 cases (8.5%) in patients treated with LAVRH (p=NS).

CONCLUSION: Our data demonstrate that early cervical cancer (less than 2 cm diameter) can be treated successfully with LARVT with similar efficacy and recurrence rates to LARVH. In our experience radical trachelectomy is a safe treatment for young women affected by early cervical cancer who want to conserve their fertility.