Regarding radical vaginal trachelectomy as a fertility-sparing procedure in women with early-stage cervical cancer-cumulative pregnancy rate in a series of 123 women.

摘要

Sir, I wish to report 1 of the 123 women from the series of Shepherd et al., who presented with extensive lymphatic metastasis 5 years after fertility-sparing surgery for carcinoma cervix. She was a 35-year-old woman who originally presented to our department in 2000 with a severely dyskaryotic smear. Cone biopsy showed invasive, moderately well-differentiated (keratinising) International Federation of Gynecology and Obstetrics stage 1B1 squamous cell carcinoma of cervix, with extensive lymphatic space involvement. In view of her desire to conserve fertility, she was referred to the specialist centre where she underwent radical vaginal trachelectomy and lap-aroscopic pelvic lymphadenectomy. She did not require completion treatment. Follow-up magnetic resonance imaging scan performed at 6 and 12 months were normal. 5 years later, she represented to us with pelvic pain radiating to the back, weight loss, night sweats and cough of 2-month duration. Examination showed supraclavicular, axillary and cervicallymphadenopathy. There was no evidence of local recurrence of disease. Computed tomography scan showed extensive lymphadenopathy from the common iliac to the left supra-clavicular region. Supraclavicular lymph node biopsy showed metastatic, moderately differentiated keratinising squamous cell carcinoma, the origin being a primary squa-mous cell cancer of the cervix. She declined palliative chemotherapy and radiotherapy, and she died a few months later.