Oncologic and obstetric outcomes of early stage cervical cancer with abdominal radical trachelectomy: Single‐institution experience

Abstract

Aim: Radical trachelectomy (RT) is a widely used fertility-sparing treatment for patients with early cervical cancer (CCA). RT, however, is an investigational treatment, and its gynecological and obstetric efficacy are being investigated. We retrospectively assessed the efficacy of abdominal RT (ART) as a fertility-sparing surgery. Methods: From 2010 to 2014, patients with stage IA2-IB1 CCA (tumor ≤2 cm) who wished to preserve their fertility underwent ART. The major outcomes were mortality, recurrence, pregnancy complications, and obstetric outcome. Results: Twenty-eight patients received ART. Adjuvant chemotherapy was performed in seven patients because of lymphovascular space invasion. During the median follow-up of 43 months, no recurrences occurred. Twelve women attempted to conceive, and eight of them became pregnant. A total of five children were born, and one baby was full term. Three cases of second trimester, and one case of third trimester preterm births were recorded. Conclusions: Fertility was preserved after ART in a moderate number of patients. The pregnancy and birth rates after ART have been improving, and increasing the full-term birth rate is the next goal. In addition, development of further types of minimally invasive surgery for CCA can be expected.

Reproductive counseling and pregnancy outcomes after radical trachelectomy for early stage cervical cancer

“…If patients have realistic expectations, they may be more proactive in trying to conceive by seeing a reproductive endocrinologist prior to surgery instead of waiting for 1 to 2 years before pursuing a fertility treatment (e.g., IVF, intrauterine insemination, ovulation induction) if needed. Other studies have demonstrated that patients who have undergone RT often need some sort of fertility treatment in order to conceive and have a successful live birth [23919]. This is consistent with our data and supports the need for a consultation with a reproductive endocrinologist preoperatively before RT allowing patients to seek a fertility treatment sooner if needed and decrease the time to conception.…”

“…However, this surgery comes with potential postoperative complications that may make pregnancies high risk [6]. Common complications include cervical stenosis and cervical insufficiency, which can lead to difficulty conceiving, infertility, preterm delivery, first- or second-trimester miscarriage, and preterm premature rupture of membranes [346789].…”

Operative and clinical outcomes of minimally invasive living-donor surgery on uterus transplantation: a literature review

“…Many pregnancies and live births have been reported after radical trachelectomy (RT), a fertility preservation treatment for cervical cancer in which the venous blood flow of the uterus is dependent on the UOV and OV, as well as UTx, using the UOV and OV only. 30 Considering this fact, the venous flow required by the gestational uterus is preserved even if only the UOV and OV are used as drainage veins. In addition, considering that there have already been reports of live births in UTx without using the UV as a drainage vein, 8,20 the use of the UOV and OV should be considered as an option for living-donor surgery.…”

Laparoscopic Surgery for Ovarian Cyst Infection with Avoidance of Ureteral Injury and Uterine Perforation following Intrauterine Insemination after Abdominal Modified Radical Trachelectomy

“…Vaginal or abdominal radical trachelectomy is currently feasible for treatment of patients with early-stage cervical cancer as fertility-sparing surgery in gynecological oncology [12, 13]. After this surgery, infertility treatment is usually necessary to achieve conception [3, 14, 15]. For example, Kasuga et al showed that, among patients who gave birth after 22 weeks of pregnancy after ART, 67% (22/33) needed infertility treatment such as IUI or IVF-ET [3].…”