Radical vaginal trachelectomy (Dargent's operation): A critical review of the literature

Abstract

Aims: To present a review of the most recent articles about radical vaginal trachelectomy (RVT). Methods: Recent literature has been reviewed, concentrating on surgical, oncological and obstetrical outcome of RVT. Data for this review were identified by searches of PubMed, and references from relevant articles using the search terms "trachelectomy" and "radical vaginal trachelectomy", "cervical carcinoma", and "fertility saving". Findings: Although a considerable number of women in their reproductive years have been diagnosed with cervical carcinoma, conservative management of early-stage cervical carcinoma did not come into practice until the beginning of the new millennium. To date, 7 gynecologic oncologic centers worldwide have reported oncological and pregnancy outcomes since Dargent made his first announcement of radical vaginal trachelectomy (RVT) in 1994. Recurrence and death rates (4.2% and 2.8%, respectively) of RVT seem to be comparable to classical radical abdominal hysterectomy. It appears that RVT's overall recurrence and death rates were similar to early-stage cervical cancer treated by radical hysterectomy (RH) or radiotherapy. Furthermore fertility results of RVT seem to be promising. A 70% pregnancy rate was reported in the women who wanted to conceive following RVT, though such patients should be informed about the risk of second trimester loss and preterm delivery. On the other hand, there is a lack of satisfactory information about the follow-up of post-RVT patients, both after the operation and during subsequent pregnancy. Conclusion: RVT looks as if it is a valid uterus-conserving surgery for women of reproductive age who have early-stage cervical carcinoma. However, in order to reach a final conclusion about the oncological and obstetrical results, further studies are needed with larger sample sizes and longer follow-up periods. © 2006 Elsevier Ltd. All rights reserved.