Die radikale vaginale Trachelektomie als fertilitätserhaltende Chirurgie bei Zervixkarzinom im Frühstadium: eine retrospektive Langzeit-Analyse mit Fokus auf die Nachsorge

Introduction: Radical vaginal trachelectomy (RVT) has proven an oncologically safe fertility-sparing treatment for young patients with early-stage cervical cancer who would consider future pregnancies. The RVT is a complex and challenging operation requiring both a well-established intraoperative setting and surgical expertise. Since this treatment is rare, it has only been examined in a few homogeneous monocentric studies comprising more than 100 patients. This study retrospectively analysed the recurrence rate, pregnancy rate and long-term follow-up of patients with early-stage cervical cancer treated with RVT at Jena University Hospital (Prof. Runnebaum) and compared them with published data. Methods: This retrospective monocentre descriptive study included patients who underwent RVT at Jena University Hospital between 1998 and 2021. The data were collected independently from both the clinical notes and the electronic SAP system and entered manually into an Excel database. The patients’ characteristics were described using percentages, minimums, maximums, and medians. Figures and tables were generated in Excel, and Kaplan–Meier graphs were created using SPSS. Results:Only three cases of recurrent disease were noted, yielding a rate of 2.6%. However, considering that follow-up data were only available for 74 patients, the adjusted rate is 4.0%. The three-year disease-free survival was 95.9%, and the three-year overall survival was 98.6%. Only one case of premalignant recurrence (CIN) was noted. Eighteen pregnancies occurred in 15 of the 74 patients who attended follow-up (20%), of which 10 resulted in a newborn: four were premature deliveries before 34 gestational weeks, and six were deliveries after 34 weeks. In addition, seven were miscarriages (including late miscarriage and intrauterine fetal death), and one case had an unknown outcome. Conclusions: In an adequate setting, RVT can be safely performed with very good oncologic outcome.