Shim, Seung-Hyuk; Lim, Myong Cheol; Kim, Hyun Jung; Lee, Maria; Nam, Eun Ji; Lee, Jung Yun; Lee, Yoo-Young; Lee, Kwang Beom; Park, Jeong Yeol; Kim, Yun Hwan; Ki, Kyung Do; Song, Yong Jung; Chung, Hyun Hoon; Kim, Sunghoon; Lee, Jeong-Won; Kim, Jae-Weon; Bae, Duk-Soo; Lee, Jong-Min
PloS one
2018NA ; 13 ( 1 ) :e0189847.
PMID : 29385139
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Shim, Seung-Hyuk - Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea.
Lim, Myong Cheol - Cancer Healthcare Research Branch, Center for Uterine Cancer, and Center for Clinical Trials, Research Institute and Hospital, Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Ilsan-ro, Ilsandong-gu, Goyang-si Gyeonggi-do, Republic of Korea.
Kim, Hyun Jung - Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea.
Lee, Maria - Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
Nam, Eun Ji - Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea.
Lee, Jung Yun - Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea.
Lee, Yoo-Young - Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada.
Lee, Kwang Beom - Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
Park, Jeong Yeol - Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Kim, Yun Hwan - Department of Obstetrics and Gynecology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.
Ki, Kyung Do - Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea.
Song, Yong Jung - Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Pusan, Korea.
Chung, Hyun Hoon - Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
Kim, Sunghoon - Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea.
Lee, Jeong-Won - Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Kim, Jae-Weon - Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
Bae, Duk-Soo - Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Lee, Jong-Min - Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea.
ABSTRACT
OBJECTIVE: This study aims to analyze the published literatures on the effect of less radical fertility-preserving procedures, such as conization or simple trachelectomy, on oncological outcomes in IA1 cervical cancer patients with lymphovascular space invasion (LVSI) through a systematic-review.
METHODS: The EMBASE and MEDLINE databases and Cochrane Library were searched for published studies reporting the oncological outcomes of conization/simple trachelectomy in these patients, through April 2017. The endpoints were recurrence and mortality rates. Data were presented as per the Meta-analysis Of Observational Studies in Epidemiology checklist. Practice guidelines were generated via the Grading of Recommendation, Assessment, Development and Evaluation system.
RESULTS: From 6,755 records, 94 full-texts articles were reviewed for eligibility, and five studies were included in this systematic review. All included studies were nonrandomized studies: two case-control studies comparing conization (n = 14) with hysterectomy (n = 24), and the other three were interrupted time series including conization (n = 20) and simple vaginal trachelectomy (n = 59). During the median follow-up duration of 43 months, no recurrence was reported in both conization and simple trachelectomy groups in IA1 patients with LVSI. From three studies reporting the fertility outcomes, the rates of pregnancy, live birth, preterm delivery, and second-trimester miscarriage were 73% (35/48), 64% (32/50), 10% (5/48), and 6% (3/48), respectively. CONCLUSION: Results suggest that simple trachelectomy or conization could be performed for IA1 cervical cancer patients with LVSI who want to preserve fertility, although these results are only based on a small number of nonrandomized studies (recommendation grade 2 = weak; evidence level D = very low). Further randomized trials with long-term study period are needed to address this issue.
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MESH
Adult, Female, *Fertility, *Guideline Adherence, Humans, Lymphatic System/*pathology, Neoplasm Invasiveness, Pregnancy, *Survival Rate, Uterine Cervical Neoplasms/physiopathology/*surgery
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