Morbidity of radical hysterectomy combined with caesarean section in pregnant patients with cervical cancer

Abstract

In pregnant patients with early stage cervical cancer, the preferred mode of delivery is a caesarean section (CS), which can be combined with a radical hysterectomy and pelvic lymphadenectomy (RHLD). The aim of this study was to compare this group of patients with non-pregnant cervical cancer patients treated by RHLD alone with regard to perioperative morbidity, oncological outcomes, and perinatal outcomes. Methods: We retrospectively reviewed all consecutive patients diagnosed with early stage cervical cancer during pregnancy who were treated by CS and RHLD at our institution. Nonpregnant counterparts served as controls and were matched on a 1 : 2 ratio. Key outcomes were perioperative complications, cancer outcome and perinatal outcome. Results: Nineteen pregnant women treated with a CS and RHLD were matched with 38 non-pregnant control patients with cervical cancer who underwent a RHLD. The only di ference in morbidity was a higher estimated perioperative blood loss in the pregnant group (1600 mL) compared to the control group (800 mL; P = 0.001), resulting in seven (36.8%) and eight (21.1%) blood transfusions (P = 0.22; OR 2.19; 95% CI 0.65 to 7.38), respectively. Conclusion: Oncological outcomes were similar with 5year overall survival rates of 94% in the pregnant group and 95% in the non-pregnant group. The neonatal survival rate was 100%. Complication rates and oncological outcomes a ter treatment with RHLD were comparable for pregnant and non-pregnant patients with early stage cervical cancer. Therefore we feel that it is safe to combine a CS with a RHLD in pregnant patients with early stage cervical cancer.

Cervical cancer in pregnancy

“…Hysterectomy right after cesarean is associated with increased blood loss and perioperative complications, such as surgical wound infection and urinary tract infection. (12) In addition, sentinel lymph node biopsy is not feasible in this scenario. Waiting six weeks after delivery could allow this less morbid lymph node evaluation.…”