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A personal experience with radical abdominal trachelectomy for the conservative management of invasive cervical cancer

Invasive cervical cancer (ICC) remains one of the most common and lethal cancers affecting women worldwide with 500,000 new cases and 250,000 deaths annually. Whilst cervical cancer screening programs have resulted in a dramatic decline in the incidence of ICC in developed countries, there has been an increase in early stage disease being diagnosed in younger women who often request a conservative approach to their disease. Approximately 15% of all cervical cancers and 45% of surgically treated stage IB ICC occur in women under age 40. In 1994 Daniel Dargent described a conservative vaginal surgical approach to the management of ICC. The indications for such an approach are shown in Table 1 and form the inclusion criteria for this reported personal series. Most Australian and US trained gynaecological oncologists are not trained in radical vaginal surgery and hence the procedure as described by Dargent has not been adopted by most. However the modified procedure using an abdominal approach to resect the cervix, upper vagina and parametrium (radical abdominal trachelectomy) is very similar in procedural steps to a radical abdominal hysterectomy and has been more commonly performed in this clinical setting in this country and the United States. The aim of this case series is to describe the author’s personal experience of patients undergoing a radical abdominal trachelectomy for conservative surgical management for invasive cervical cancer.