Background/Objectives: The primary aim of this systematic review was to evaluate fertility outcomes and the oncological safety of different surgical techniques of radical trachelectomy (RT).Methods: The systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search on PubMed, Embase, and Google Scholar was performed between 1 November 2023 and 31 March 2024 with no limits for the time of publication.Results: In total, 56 studies met the inclusion criteria: 22 for abdominal RT (1712 patients), 14 for endoscopic RT (445 patients), and 22 for vaginal RT (1158 patients). Data regarding certain steps of the procedure (uterine artery preservation, autonomous nerve-sparing, abdominal cerclage, types of sutures used for the cerclage, uterine dilatation during cerclage placement, prolongation of uterine catheterization, type of uterovaginal anastomosis, antibiotic prophylaxis, and suppression of menstruation) were extracted and analyzed with regard to the obstetrical and oncological outcomes. Endoscopic RT was associated with a significantly higher pregnancy rate and a lower rate of preterm deliveries. Uterine artery preservation was associated with a higher live birth rate. Nerve-sparing RT resulted in a higher pregnancy rate, but no differences in the attempt for pregnancy and live birth rates were observed.Conclusions: Taking into account the obstetrical outcomes, it seems that the preferred option for radical RT is an endoscopic procedure with preservation of the uterine artery and the pelvic autonomic nerves. However, the safety of the endoscopic approach should be evaluated in prospective trials.
背景/目的：本系统综述的主要目的是评估不同根治性宫颈切除术（RT）手术技术的生育结局及肿瘤安全性。 方法：本系统综述遵循系统综述和荟萃分析优先报告项目（PRISMA）指南进行。于2023年11月1日至2024年3月31日期间，在PubMed、Embase和Google Scholar数据库进行了系统性文献检索，未限制发表时间。 结果：共有56项研究符合纳入标准：其中22项关于经腹RT（1712例患者），14项关于内镜RT（445例患者），22项关于经阴道RT（1158例患者）。研究提取并分析了手术特定步骤（子宫动脉保留、自主神经保留、腹部环扎术、环扎术所用缝合线类型、环扎术放置期间的子宫扩张、延长子宫导管留置时间、子宫阴道吻合类型、抗生素预防及月经抑制）与产科及肿瘤结局的关系。内镜RT与显著更高的妊娠率和更低的早产率相关。保留子宫动脉与更高的活产率相关。保留神经的RT可提高妊娠率，但在妊娠尝试和活产率方面未观察到差异。 结论：综合考虑产科结局，内镜下保留子宫动脉和盆腔自主神经的根治性宫颈切除术似乎是更优选择。然而，内镜手术的安全性仍需在前瞻性试验中进一步评估。
肿瘤(癌症)患者之家