Laparoscopic versus abdominal radical trachelectomy for early-stage cervical cancer

Background: Radical trachelectomy is considered a safe and achievable treatment modality for patients with early-stage cervical cancer; and several surgical approaches for this procedure have been proposed. We aimed to compare the clinical outcomes of patients with early-stage cervical cancer who underwent laparoscopic trachelectomy (LRT) with those who underwent abdominal radical trachelectomy (ART). Methods: In this single-center retrospective study, we included patients with early-stage cervical cancer who wished to undergo fertility-sparing surgery. Six patients underwent LRT with sentinel node biopsy and 20 underwent ART with lymphadenectomy. Short- and long-term outcomes were compared between the two patient groups. Results: LRT resulted in significantly less blood loss, a longer surgical time and a shorter hospital stay than did ART. No intra-operative complications were observed in either group. The rate of postoperative complications was significantly lower for LRT than that of ART (33% vs. 80%, p = 0.03). The rate of postoperative cervical stenosis was significantly lower for LRT than that of ART (0% vs. 47%, p = 0.03). During a median follow-up of 19 months, no recurrences were observed in the LRT group. In contrast, two recurrences were observed after ART during a median follow-up of 116 months. No deaths due to the disease occurred in either group. Conclusions: LRT resulted in less blood loss, a shorter hospital stay, and fewer postoperative complications compared with that in ART, without worsening oncological prognosis.

Cervical cancer; Radical trachelectomy; Laparoscopic surgery; Fertility treatment

[1] Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. The Lancet Global Health. 2020; 8: e191–e203.

[2] Salvo G, Pareja R, Ramirez PT. Minimally invasive radical trachelectomy: considerations on surgical approach. Best Practice & Research Clinical Obstetrics & Gynaecology. 2021; 75: 113–122.

[3] Taddese AA, Tilahun BC, Awoke T, Atnafu A, Mamuye A, Mengiste SA. Deep-learning models for image-based gynecological cancer diagnosis: a systematic review and meta-analysis. Frontiers in Oncology. 2023; 13: 1216326.

[4] Daoud T, Sardana S, Stanietzky N, Klekers AR, Bhosale P, Morani AC. Recent imaging updates and advances in gynecologic malignancies. Cancers. 2022; 14: 5528.

[5] Tîrnovanu MC, Cojocaru E, Tîrnovanu VG, Toma B, Tîrnovanu ȘD, Lozneanu L, et al. The role of ultrasound in diagnosing endometrial pathologies: adherence to IETA group consensus and preoperative assessment of myometrial invasion in endometrial cancer. Diagnostics. 2025; 15: 891.

[6] Mahale N, Kumar N, Mahale A, Ullal S, Fernandes M, Prabhu S. Validity of ultrasound with color Doppler to differentiate between benign and malignant ovarian tumours. Obstetrics & Gynecology Science. 2024; 67: 227–234.

[7] Tian Y, Luo H. Diagnostic accuracy of transvaginal ultrasound examination for local staging of cervical cancer: a systematic review and meta-analysis. Medical Ultrasonography. 2022; 24: 348–355.

[8] Fischerová D, Cibula D. The role of ultrasound in primary workup of cervical cancer staging (ESGO, ESTRO, ESP cervical cancer guidelines). Ceska Gynekologie. 2019; 84: 40–48.

[9] Fischerova D, Smet C, Scovazzi U, Sousa DN, Hundarova K, Haldorsen IS. Staging by imaging in gynecologic cancer and the role of ultrasound: an update of European joint consensus statements. International Journal of Gynecological Cancer. 2024; 34: 363–378.

[10] Kohler C, Plaikner A, Siegler K, Hertel H, Hasenbein K, Petzel A, et al. Radical vaginal trachelectomy: long-term oncologic and fertility outcomes in patients with early cervical cancer. International Journal of Gynecological Cancer. 2024; 34: 799–805.

[11] Salvo G, Ramirez PT, Leitao MM, Cibula D, Wu X, Falconer H, et al. Open vs. minimally invasive radical trachelectomy in early-stage cervical cancer: international radical trachelectomy assessment study. American Journal of Obstetrics and Gynecology. 2022; 226: 97.e1–97.e16.

[12] Wu CJ, Chang WC, Chen CH, Chen CA, Huang SC, Sheu BC. Radical trachelectomy for early stage cervical cancer: a case series and literature review. Taiwanese Journal of Obstetrics and Gynecology. 2017; 56: 143–146.

[13] Bellotti JA, Gutierres IG, Furtado YL, Patury P, Figueiredo JA, Guitmann G, et al. Surgical, oncologic, and obstetric outcomes of radical trachelectomy in early-stage cervical cancer: results from a retrospective cohort study at Brazil National Cancer Institute. Frontiers in Oncology. 2024; 14: 1267625.

[14] Bentivegna E, Gouy S, Maulard A, Chargari C, Leary A, Morice P. Oncological outcomes after fertility-sparing surgery for cervical cancer: a systematic review. The Lancet Oncology. 2016; 17: e240–e253.

[15] Han L, Chen Y, Zheng A, Tan X, Chen H. Minimally invasive versus abdominal radical trachelectomy for early-stage cervical cancer: a systematic review and meta-analysis. American Journal of Cancer Research. 2023; 13: 4466–4477.

[16] Matsuo K, Chen L, Mandelbaum RS, Melamed A, Roman LD, Wright JD. Trachelectomy for reproductive-aged women with early-stage cervical cancer: minimally invasive surgery versus laparotomy. American Journal of Obstetrics and Gynecology. 2019; 220: 469.e1–469.e13.

[17] Lv Z, Wang YY, Wang YW, He JJ, Lan WW, Peng JY, et al. A meta-analysis of treatment for early-stage cervical cancer: open versus minimally invasive radical trachelectomy. BMC Pregnancy and Childbirth. 2023; 23: 727.

[18] Konishi H, Tanaka T, Maruoka H, Kogata Y, Fujiwara S, Tanaka Y, et al. Reproductive outcomes after radical abdominal trachelectomy for cervical cancer. European Journal of Gynaecological Oncology. 2021; 42: 688–693.

[19] Tanaka T, Ueda S, Miyamoto S, Hashida S, Terada S, Konishi H, et al. Comparison of prognosis between minimally invasive and abdominal radical hysterectomy for patients with early-stage cervical cancer. Current Oncology. 2022; 29: 2272–2283.

[20] Tanaka T, Terai Y, Ashihara K, Tsunetoh S, Akagi H, Yamada T, et al. The detection of sentinel lymph nodes in laparoscopic surgery for uterine cervical cancer using 99m-technetium-tin colloid, indocyanine green, and blue dye. Journal of Gynecologic Oncology. 2017; 28: e13.

[21] Tanaka T, Sasaki S, Tsuchihashi H, Terai Y, Yamamoto K, Yamada T, et al. Which is better for predicting pelvic lymph node metastases in patients with cervical cancer: fluorodeoxyglucose-positron emission tomography/computed tomography or a sentinel node biopsy? A retrospective observational study. Medicine. 2018; 97: e0410.

[22] Tanaka T, Miyamoto S, Terada S, Kogata Y, Sasaki H, Tsunetoh S, et al. Intraperitoneal cytology after laparoscopic radical hysterectomy with vaginal closure without the use of a manipulator for cervical cancer: a retrospective observational study. Cancer Management and Research. 2019; 11: 7015–7020.

[23] Ramirez PT, Frumovitz M, Pareja R, Lopez A, Vieira M, Ribeiro R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. The New England Journal of Medicine. 2018; 379: 1895–1904.

[24] Vieira MA, Rendón GJ, Munsell M, Echeverri L, Frumovitz M, Schmeler KM, et al. Radical trachelectomy in early-stage cervical cancer: a comparison of laparotomy and minimally invasive surgery. Gynecologic Oncology. 2015; 138: 585–589.

[25] Xu M, Huo C, Huang C, Liu Y, Ling X, Xu G, et al. Round ligament suspension and vaginal purse-string suture: newly optimized techniques to prevent tumor spillage in laparoscopic radical trachelectomy for cervical cancer. Journal of Obstetrics and Gynaecology Research. 2022; 48: 1867–1875.

[26] Kucukmetin A, Biliatis I, Ratnavelu N, Patel A, Cameron I, Ralte A, et al. Laparoscopic radical trachelectomy is an alternative to laparotomy with improved perioperative outcomes in patients with early-stage cervical cancer. International Journal of Gynecological Cancer. 2014; 24: 135–140.

[27] Nick AM, Frumovitz MM, Soliman PT, Schmeler KM, Ramirez PT. Fertility sparing surgery for treatment of early-stage cervical cancer: open vs. robotic radical trachelectomy. Gynecologic Oncology. 2012; 124: 276–280.

[28] He Z, Bian C, Xie C. Fertility-sparing surgery in early-stage cervical cancer: laparoscopic versus abdominal radical trachelectomy. BMC Women’s Health. 2022; 22: 241.

[29] Mullapally SK, Digumarti L, Digumarti R. Cervical cancer in low- and middle-income countries: a multidimensional approach to closing the gaps. JCO Oncology Practice. 2022; 18: 423–425.

[30] DeBoer RJ, Umutoni V, Bazzett-Matabele L, Katznelson E, Nguyen C, Umwizerwa A, et al. Cervical cancer treatment in Rwanda: resource-driven adaptations, quality indicators, and patient outcomes. Gynecologic Oncology. 2022; 164: 370–378.

[31] Grover S, Luckett R, Bhatia RK, Ralefala T, Seiphetlheng A, Ramogola-Masire D, et al. Neoadjuvant chemotherapy and less invasive surgery for the management of early stage cervical cancer: a brief report from Botswana. Gynecologic Oncology Reports. 2022; 42: 101032.