Clinical Value of the Fertility-preserving Surgery in Cervical Cancer

Cervical Cancer Clinical Trial

Official title:

Clinical Value of the Fertility-preserving Surgery in Cervical Cancer -- the Feasibility of the 'Cuff-sleeve' Suture Method in the Ascending Branch of Uterine Artery Preserved Radical Trachelectomy

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05806125
• Other study ID #: SYSKY-2022-038-01
• Status: Recruiting
• Start date: January 1, 2023
• Est. completion date: December 1, 2024

Study information

• Verified date: April 2023
• Source: Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

Purpose: To evaluate the clinical value of preserving the ascending branch of the uterine artery in improving the uterine blood supply after radical trachelectomy (RT). Method: This study will include 100 patients with early-stage cervical cancer, who undergo RT with the preservation of the ascending branch of the uterine artery. A new skill called the "cuff-sleeve" suture method is introduced to wrap the vagina around the stump cervix, wherein they are sutured using a 2-0 absorbable suture by placing two cross-stitches in the anterior and posterior wall, respectively, without piercing the cervical mucosa layer or damaging the uterine arteries. Study groups: The patients will be categorized into two groups. Patients in the postoperative group will undergo computed tomography angiography (CTA) after surgery and patients in the preoperative group will undergo CTA before RT. Data collection: Data regarding individual patient characteristics, International Federation of Gynecology and Obstetrics (FIGO) stage, histologic subtype, lymphovascular space involvement (LVSI) status, recurrence, CTA data, fertility results, and obstetric outcomes will be collected for the patients in the postoperative group. The CTA findings of the preoperative group will be obtained. Statistical methods: Statistical analyses were performed using IBM SPSS Statistics, version 26. The t-test is used for analyzing the continuous variables and the chi-squared test for categorical variables.

Description:

Purpose: To evaluate the clinical value of preserving the ascending branch of the uterine artery in improving the uterine blood supply after radical trachelectomy (RT). Method: This study will include 100 patients with early-stage cervical cancer, who undergo RT with the preservation of the ascending branch of the uterine artery, at Sun Yat-sen Memorial Hospital, Sun Yat-sen University. The investigators attribute the uterine artery occlusion to the inevitable injury of the remaining uterine arteries during the ligation of the descending branch of the uterine artery and continuous or intermittent suturing. Hence, the investigators will carefully skeletonize the three branches of the uterine artery, ligates the vaginal and cervical branches, and preserves the ascending branch of the uterine artery under direct vision. Furthermore, a new skill called the "cuff-sleeve" suture method is introduced to wrap the vagina around the stump cervix, wherein they are sutured using a 2-0 absorbable suture by placing two cross-stitches in the anterior and posterior wall, respectively, without piercing the cervical mucosa layer or damaging the uterine arteries. Study groups: The patients will be categorized into two groups. All patients in the postoperative group will undergo computed tomography angiography (CTA) to evaluate the status of the preserved ascending branch and the residual uterine blood supply pattern after surgery. Patients in the preoperative group will undergo CTA before RT to determine the uterine blood supply pattern in healthy individuals. Data collection: Data regarding individual patient characteristics, International Federation of Gynecology and Obstetrics (FIGO) stage, histologic subtype, lymphovascular space involvement (LVSI) status, recurrence, CTA data, fertility results, and obstetric outcomes will be collected for the patients in the postoperative group. The CTA findings of the preoperative group will be obtained. The CTA data are mainly analyzed to determine the arteries supplying the uterus. The investigators consider a vessel as a supplying artery only when it is continuous from its origin up to the entry into the uterus and then branches. The uterine blood supply in patients is divided into three patterns based on the supplying vessels. The first is the ovarian artery-supplying pattern, wherein the residual uterus is supplied only by the ovarian arteries. The second is the hybrid-supplying pattern, in which an ovarian artery or a newly formed artery supplied the residual uterus along with the contralateral uterine artery. The third is the uterine artery-supplying pattern, wherein the residual uterus is supplied only by the uterine arteries. Furthermore, the diameter of the visualized supplying vessels is recorded. The diameters of the uterine and newly formed arteries are measured 2 cm before they enter the corpus uteri. However, the ovarian artery diameter is measured at its origin from the aorta ventralis, beside the external iliac artery, and 2 cm before it enters the corpus uteri since the ovarian arteries are convoluted. Statistical methods: Statistical analyses were performed using IBM SPSS Statistics, version 26. The t-test is used for analyzing the continuous variables and the chi-squared test for categorical variables.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 100
• Est. completion date: December 1, 2024
• Est. primary completion date: December 1, 2024
• Accepts healthy volunteers: No
• Gender: Female
• Age group: 20 Years to 45 Years

Eligibility

Inclusion Criteria:

• 1. Female, =20 years old; 2. Clinical diagnosis of cervical cancer; 3. Received radical trachelectomy; 4. Have good compliance, and can complete the enrollment by the requirements of the trial; 5. Sign informed consent and agree to the collection and use of their data.

Exclusion Criteria:

• 1. Have received other anti-tumor treatments or received tumor surgery before enrollment; 2. With other malignant tumors; 3. With uncontrollable neurological, psychiatric, or mental disorders.

Related Conditions & MeSH terms

• Cervical Cancer
• Uterine Cervical Neoplasms

Locations

Country	Name	City	State
China	The Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University	Guangzhou	Guangdong

Sponsors (1)

Lead Sponsor	Collaborator
Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University

Country where clinical trial is conducted

China, 

References & Publications (6)

Arbyn M, Weiderpass E, Bruni L, de Sanjose S, Saraiya M, Ferlay J, Bray F. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020 Feb;8(2):e191-e203. doi: 10.1016/S2214-109X(19)30482-6. Epub 2019 Dec 4. Erratum In: Lancet Glob Health. 2022 Jan;10(1):e41. — View Citation

Bentivegna E, Maulard A, Pautier P, Chargari C, Gouy S, Morice P. Fertility results and pregnancy outcomes after conservative treatment of cervical cancer: a systematic review of the literature. Fertil Steril. 2016 Oct;106(5):1195-1211.e5. doi: 10.1016/j.fertnstert.2016.06.032. Epub 2016 Jul 16. — View Citation

Cao DY, Yang JX, Wu XH, Chen YL, Li L, Liu KJ, Cui MH, Xie X, Wu YM, Kong BH, Zhu GH, Xiang Y, Lang JH, Shen K; China Gynecologic Oncology Group. Comparisons of vaginal and abdominal radical trachelectomy for early-stage cervical cancer: preliminary results of a multi-center research in China. Br J Cancer. 2013 Nov 26;109(11):2778-82. doi: 10.1038/bjc.2013.656. Epub 2013 Oct 29. — View Citation

Dargent D, Martin X, Sacchetoni A, Mathevet P. Laparoscopic vaginal radical trachelectomy: a treatment to preserve the fertility of cervical carcinoma patients. Cancer. 2000 Apr 15;88(8):1877-82. — View Citation

Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, Chon HS, Chu C, Clark R, Cohn D, Crispens MA, Damast S, Dorigo O, Eifel PJ, Fisher CM, Frederick P, Gaffney DK, Han E, Huh WK, Lurain JR, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Fader AN, Remmenga SW, Reynolds RK, Tillmanns T, Ueda S, Wyse E, Yashar CM, McMillian NR, Scavone JL. Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019 Jan;17(1):64-84. doi: 10.6004/jnccn.2019.0001. — View Citation

Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol. 2008 Mar;9(3):297-303. doi: 10.1016/S1470-2045(08)70074-3. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	The pattern of the uterine blood supply	The first is the ovarian artery-supplying pattern, wherein the residual uterus is supplied only by the ovarian arteries. The second is the hybrid-supplying pattern, in which an ovarian artery or a newly formed artery supplied the residual uterus along with the contralateral uterine artery. The third is the uterine artery-supplying pattern, wherein the residual uterus is supplied only by the uterine arteries.	The postoperative group will undergo CTA 3 months after surgery while the preoperative group will undergo CTA 1 week before the surgery.