Nerve-Sparing Radical Abdominal Trachelectomy VersusNerve-Sparing Radical Hysterectomy in Early-Stage(FIGO IA2-IB) Cervical Cancer

Gent, Mignon D J M van; Haak, Lukas Wesley van den; Gaarenstroom, Katja N.; Peters, Alexander; Poelgeest, Mariëtte I.E. van; Trimbos, J. Baptist; Kroon, Cor D. de

doi:10.1097/igc.0000000000000114

Cited by 35 publications

(31 citation statements)

References 34 publications

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“…Fertility-sparing surgery consisted of a nerve-sparing abdominal radical trachelectomy with pelvic lymphadenectomy. We performed nerve-sparing abdominal trachelectomy from 2005 onwards, similar to the Swift procedure for nerve-sparing radical hysterectomy as described by van Gent et al7 Intra-operative frozen sections of the pelvic lymph nodes as well as the isthmus were evaluated. In cases of tumor-positive lymph nodes or isthmus, surgery was converted into radical hysterectomy or the uterus was left in situ, depending on the stage of the operation.…”

Section: Methodsmentioning

confidence: 99%

Fertility-sparing surgery of cervical cancer >2 cm (International Federation of Gynecology and Obstetrics 2009 stage IB1–IIA) after neoadjuvant chemotherapy

Tesfai

Kroep

Gaarenstroom

et al. 2019

Int J Gynecol Cancer

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ObjectiveTo assess the feasibility, safety, oncological, and obstetric outcomes in patients with cervical tumors >2 cm treated with neoadjuvant chemotherapy in preparation for abdominal radical trachelectomy.MethodsA retrospective analysis of patients with cervical cancer >2 cm (up to 6 cm) was conducted in patients who were selected to receive neoadjuvant chemotherapy before abdominal radical trachelectomy. Surgical and clinical outcomes were examined in relation to radiological and pathological results. In addition, obstetric outcomes were described. The Mann–Whitney U test and Fisher’s exact test were performed to compare radiological findings between successful and unsuccessful abdominal radical trachelectomy procedures. International Federation of Gynecology and Obstetrics (FIGO) 2009 staging classification was used for this study.ResultsA total of 19 women were treated with neoadjuvant chemotherapy for cervical tumors >2 cm at our institution between May 2006 and July 2018. The median age was 28 years (range 19–36). The distribution of FIGO stages was seven patients stage IB1 (37%), 10 patients stage IB2 (53%), and two patients (10%) stage IIA. Mean clinical tumor size was 4.4 cm (range 3.5–6.0). Histology revealed 74% cases of squamous cell carcinoma. The remaining patients had adenocarcinoma (21%) and only one patient had clear cell adenocarcinoma (5%). Chemotherapy consisted of six weekly cycles of cisplatin (70 mg/m2) and paclitaxel (70 mg/m2). In 15 of the 19 patients (74%) fertility was successfully preserved. In the four patients in whom fertility preservation failed, one patient had stable disease after three cycles and did not meet the criteria for fertility-sparing surgery and three patients had intra- or post-operative indications for adjuvant therapy. Three of the 19 patients (15.7%) had a relapse, two of whom died. One case was in the group of successful abdominal radical trachelectomy.ConclusionNeoadjuvant chemotherapy followed by fertility-sparing surgery may be a feasible and safe option in select patients with cervical tumors >2 cm. Unfavorable prognostic factors are defined as non-responsiveness and non-squamous pathology, which can help in patient selection for fertility-sparing surgery.

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Section: Methodsmentioning

confidence: 99%

Fertility-sparing surgery of cervical cancer >2 cm (International Federation of Gynecology and Obstetrics 2009 stage IB1–IIA) after neoadjuvant chemotherapy

Tesfai

Kroep

Gaarenstroom

et al. 2019

Int J Gynecol Cancer

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“…Data on the spontaneous conception rate suggest that up to 61% (151/248) of women who conceived following a trachelectomy required assisted reproduction techniques to achieve a pregnancy, which is a higher rate when compared with the population who have not had a trachelectomy, although underlying fertility causes were not always documented. 8,11,12,14,16,18,21,22,25,28 The mean time from surgery to conception was 31 months, with the mean surgical follow-up period of 47 months. The pooled live birth rate of women pregnant following trachelectomy was 62.8% (404/643), with several studies published before all pregnant women had completed their pregnancies.…”

Section: Systematic Reviewmentioning

confidence: 99%

The management of pregnancy after trachelectomy for early cervical cancer

Tirlapur

Willmott

Lloyd

et al. 2017

The Obstetric & Gynaecologis

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Key content Cervical cancer continues to affect many women in the UK with over half under the age of 45 years at the time of diagnosis; with a trend towards starting families later in life this raises fertility concerns. While the standard treatment for stage IA2 or IB1 cervical cancer is a radical hysterectomy, radical trachelectomy has been shown to have equivalent 5‐year survival and is a surgical option if there is a wish to preserve fertility. Although trachelectomies are performed by gynaecological oncologists, the management of any subsequent pregnancies falls under the remit of obstetricians who therefore require a sound knowledge of the procedure and potential obstetric sequelae. Pregnancies following trachelectomy are high risk because of the increased rate of mid‐trimester miscarriage and preterm delivery, often as a consequence of preterm prelabour rupture of membranes. Delivery is by caesarean section, traditionally by classical section as a permanent isthmic suture is placed at the time of trachelectomy, but nowadays a transverse incision may be used to reduce morbidity and the implications on future fertility. Learning objectives Management of a pregnancy following radical trachelectomy. Intrapartum care of post‐radical trachelectomy pregnancy and complication risks. Impact of trachelectomy and subsequent pregnancy on the woman. Ethical issues Informed consent surrounding trachelectomy and future pregnancies.

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“…11 The techniques of the LNSRH and the Swift procedure have been described previously. 1,10,12 During the periods January 1999 to January 2001 and January 2005 to October 2006, there was a transition from 1 technique to the next. Surgical procedures performed in these periods were not included in the analysis to exclude the possibility of mixing up different techniques and possible influence on results because of a learning curve.…”

Section: Methodsmentioning

confidence: 99%

Long-Term Oncological Outcome After Conventional Radical Hysterectomy Versus 2 Nerve-Sparing Modalities for Early Stage Cervical Cancer

Gent¹,

Rademaker²,

Veer³

et al. 2017

International Journal of Gynecological Cancer

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Nerve-Sparing Radical Abdominal Trachelectomy VersusNerve-Sparing Radical Hysterectomy in Early-Stage(FIGO IA2-IB) Cervical Cancer

Abstract: Nerve-sparing radical abdominal trachelectomy seems safe and effective in women with early-stage cervical cancer who wish to preserve fertility. Respective women should be informed about this treatment option, especially if the tumor is too large for radical vaginal trachelectomy.

Cited by 35 publications

References 34 publications

Fertility-sparing surgery of cervical cancer >2 cm (International Federation of Gynecology and Obstetrics 2009 stage IB1–IIA) after neoadjuvant chemotherapy

Fertility-sparing surgery of cervical cancer >2 cm (International Federation of Gynecology and Obstetrics 2009 stage IB1–IIA) after neoadjuvant chemotherapy

The management of pregnancy after trachelectomy for early cervical cancer

Long-Term Oncological Outcome After Conventional Radical Hysterectomy Versus 2 Nerve-Sparing Modalities for Early Stage Cervical Cancer

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