Congress Abstracts 2006

309

RADICAL VAGINAL TRACHELECTOMY TO PRESERVE FERTILITY IN THE TREATMENT OF EARLY CERVICAL CANCER. Michelle Casale, RN, BSN, and Lois Almadrones, Memorial Sloan-Kettering Cancer Center, New York, NY.

Laparoscopic radical vaginal trachelectomy (LRVT) offers fertility preservation for women of childbearing age diagnosed with stage 1A2 or 1B1 squamous cell or adenocarcinoma of the cervix. This curative procedure is an alternative to standard radical hysterectomy and offers future fertility potential and better quality of life in women who meet eligibility criteria. Oncology nurses need to know the risks and benefits and eligibility criteria for LVRT in order to properly counsel candidates. Information about future fertility, contraception, and short- and long- term follow-up care are also part of nursing management.

It is estimated that 43% of women diagnosed with cervical cancer are of childbearing age; therefore, fertility may be a major concern for these women. Trained gynecologic oncologists may offer LVRT as a viable alternative to standard treatment in a select group of women. Strict criteria are applied to reduce recurrence risk. These criteria include the following: tumor is confined to cervix and measures less than 2cm and the woman desires future pregnancy.

Surgery includes the laparoscopic evaluation of the abdomen and pelvic organs and pelvic lymphadenectomy. Lymph nodes, the upper endocervical margin, and an endocervical curettage are assessed by frozen section analysis; all must be negative before proceeding with LVRT. Best outcome is achieved when the upper endocervical margin is free of disease by 8-10 mm. A cerclage is done to assure cervical competence during pregnancy.

LVRT is associated with less blood loss, shorter hospital stay, and shorter time to normal voiding patterns compared with radical hysterectomy. Follow-up includes colposcopic examination, including a Pap smear every 4 months for 2 years and every 6 months thereafter. Pregnancy is not recommended for 6-12 months after LVRT, and delivery is by cesarean section. Combined studies reported 96 pregnancies in 61 women post LVRT resulting in 51 live births.