Oncological and obstetric outcomes after fertility-sparing radical abdominal trachelectomy for early stage cervical cancer: a tertiary centre’s 10 years’ experience

Ayhan, Ali; Tohma, Yusuf Aytaç; Şahin, Hanifi; Kocaman, Eda; Tunç, Mehmet; Haberal, Asuman Nihan

doi:10.1080/01443615.2018.1498830

Cited by 10 publications

(8 citation statements)

References 28 publications

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“…This approach may be favored in patients with stage I tumors >2 cm who are still considered to be candidates for FSS [10]. The disadvantages of ART compared with LRT or VRT include higher blood loss, transfusion risk, and wound complications as well as longer hospital stay [6,19,24]. Fertility is successfully preserved in 60% to 93% of the patients undergoing ART (Table 2).…”

Section: Methodsmentioning

confidence: 99%

“…The surgical interventions included vaginal radical trachelectomy (VRT, N = 19) [2,7,9,18,21,26,32,35,36,38,42,43,[45][46][47][48]51,54,55], abdominal radical trachelectomy (ART, N = 15) [2,6,10,14,16,19,[22][23][24]27,28,30,39,52,53], minimally invasive radical trachelectomy (MIS-RT, N = 9) (laparoscopic radical trachelectomy [LRT], N = 7; robotic radical trachelectomy, N = 2) [12,17,20,26,27,29,32,37,45] and simple vaginal trachelectomy [SVT] or conization, (N = 15) (SVT, N = 6; cone, N = 6; both, N = 3) [8,11,13,15,25,33,34,40,41,44,47,49,50,56−58]. Neoadjuvant chemotherapy (NACT) was used primarily in 6 studies, followed by SVT or cone (N = 2), VRT (N = 1), or ART (N = 1) [23,31,38...…”

Section: Primary Study Characteristicsmentioning

confidence: 99%

“…A clinical examination in conjunction with pelvic magnetic resonance imaging allows for accurate estimation of tumor size and invasion. The addition of computerized tomography or positron emission tomography/ computerized tomography is also described for better characterization of the extent of disease (i.e., lymphadenopathy and distant metastasis) [6,10,19,22,26,28,43,45,46,48,51,52].…”

Section: Patient Selection and Preoperative Evaluationmentioning

confidence: 99%

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Fertility-Sparing Surgery for Early-Stage Cervical Cancer: A Systematic Review of the Literature

Kuznicki¹,

Chambers²,

Morton³

et al. 2021

Journal of Minimally Invasive Gynecology

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Objective: This systematic review aimed to evaluate oncologic and reproductive outcomes after fertility-sparing surgery (FSS) for early-stage cervical cancer (early CC). Data Sources: Ovid MEDLINE, Ovid EMBASE, and Cochrane CENTRAL were searched from 1980 to the present using Medical Subject Headings terms; other controlled vocabulary terms; and keywords related to fertility, cervical cancer, and surgical techniques. Methods of Study Selection: A total of 2415 studies were screened, with 53 studies included. Studies reporting recurrences with a median follow-up of 12 months in early CC (International Federation of Gynecology and Obstetrics 2009 stages IA with lymphovascular space invasion, IB, or IIA) of traditional histologic type undergoing FSS were included. Tabulation, Integration, and Results: The studies were grouped by intervention, including vaginal radical trachelectomy (VRT), abdominal radical trachelectomy (ART), minimally invasive radical trachelectomy (MIS-RT), and conization or simple trachelectomy (ST), and studies involving neoadjuvant chemotherapy (NACT). Combined rates of recurrence (RR), cancer death (CDR), pregnancy (PR), and live birth (LBR) were calculated per procedure on the basis of all included studies that reported outcomes on that procedure. The results were as follows:

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Section: Methodsmentioning

confidence: 99%

Section: Primary Study Characteristicsmentioning

confidence: 99%

Section: Patient Selection and Preoperative Evaluationmentioning

confidence: 99%

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Fertility-Sparing Surgery for Early-Stage Cervical Cancer: A Systematic Review of the Literature

Kuznicki¹,

Chambers²,

Morton³

et al. 2021

Journal of Minimally Invasive Gynecology

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“…The high rate of preterm delivery among pregnant patients was another important concerns, the reason for which is believed to be mechanical or ascending infection, or both [23]. Some researchers believed that it is unnecessary to excise all of the cervical tissue during surgery and that it is beneficial to retain cervical tissue of up to 5-10 mm to reduce the incidence of premature birth as much as possible [24]. Some researchers put forward that cerclage could be adopted during surgery to prevent cervical insufficiency [20,25].…”

Section: Discussionmentioning

confidence: 99%

The oncological and obstetric results of radical trachelectomy as a fertility-sparing therapy in early-stage cervical cancer patients

Chen¹,

Li²,

Zhu³

et al. 2022

BMC Women's Health

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Purpose This study explored the oncological and obstetric results of radical trachelectomy (RT) in early-stage cervical cancer patients. Methods A retrospective analysis was conducted the oncological and obstetric results of 23 patients with early cervical cancer (stages IA2–IB3; International Federation of Gynecology and Obstetrics, 2018) who underwent RT in The Maternal and Child Health Care Hospital of Guiyang, China, from October 2004 to September 2018. Results 23 patients had cervical tumors of the squamous cell carcinoma histological type. All 23 patients retained reproductive function. The mean follow-up time was 112.87 ± 55.75 (36–199) months. The median tumor size was 2.00 ± 1.35 cm (imperceptible to the eyes 5.00 cm). No recurrence was observed in any of the patient cases. Among the patients with a tumor size > 4 cm (up to 5 cm), three patients who wished to preserve fertility accepted RT following neoadjuvant chemotherapy The pregnancy outcomes were as follows: 8 cases (47.06%) out of 17 cases who attempting pregnancy conceived 12 times.First-trimester abortion and the voluntary abandonment of pregnancy occurred in 4 cases (33.33%), respectively, one patient performed deliberate termination at 24 weeks of gestation. Second-trimester abortion occurred in three cases (25.0%) for chorioamnionitis. Premature delivery at 32 weeks occurred in one case (8.33%). Conclusion Radical trachelectomy is a safe and effective treatment for women with early-stage cervical cancer preserving fertility biology. Patients with a cervical tumor sized > 4 cm can be pregnant after neoadjuvant chemotherapy and RT. Accordingly, this treatment is worthy of further exploration.

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“…In stage 1a2 cancers, the risk of recurrence after surgery is 3-5% and 5-year survival is 96-100% (4,5). Some authors suggest that conservative treatment can be applied for these tumors due to the low rate of parametrial and lymphatic involvement (2,4,(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Factors affecting parametrial involvement in cervical cancer patients with tumor size ≤4 cm and selection of low-risk patient group

Akıllı

Tohma

Günakan

et al. 2021

J Turkish German Gynecol Assoc

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Objective: The primary aim of this study was to evaluate the factors affecting parametrial involvement in cervical cancer patients with tumor size ≤4 cm and selection of the low-risk patient group based on long-term oncologic outcomes. Material and Methods: Cervical cancer patients operated in the gynecologic oncology division between 2007 and 2013 were retrospectively evaluated. One-hundred and sixty-eight patients with tumor size ≤4 cm were identified. Of these, 159 (86.8%) underwent radical hysterectomy plus pelvic-para-aortic lymphadenectomy and nine (13.2%) underwent fertility-sparing surgery [radical trachelectomy (n=7); large conization (n=2)]. Factors affecting parametrial invasion, including lymphovascular space invasion (LVSI), deep stromal invasion (DSI), lymph node metastases, and tumor size, were evaluated. Statistical analyses were performed using SPSS 23.0 (IBM Corp., Armonk, NY, USA). Results: Median age was 49.5 years and median tumor size was 2.5 cm (0.45-4 cm). In both univariate and multivariate analyses, the risk of parametrial involvement was increased with LVSI with a hazard ratio (HR) of 3.45 [95% confidence interval (CI): 1.1-10.8] and DSI with a HR of 4.1 (95% CI: 1.18-14.8), while tumor size of ≤2 cm was only significant in univariate analyses. Furthermore, 26 early-stage patients were identified with low-risk factors and they had no parametrial involvement, lymph node metastases, recurrence, or death from disease over 77 months. Conclusion: Parametrial involvement in low-risk cervical cancer is very rare and less radical procedures may be safe in these patients. (J Turk

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Oncological and obstetric outcomes after fertility-sparing radical abdominal trachelectomy for early stage cervical cancer: a tertiary centre’s 10 years’ experience

Cited by 10 publications

References 28 publications

Fertility-Sparing Surgery for Early-Stage Cervical Cancer: A Systematic Review of the Literature

Fertility-Sparing Surgery for Early-Stage Cervical Cancer: A Systematic Review of the Literature

The oncological and obstetric results of radical trachelectomy as a fertility-sparing therapy in early-stage cervical cancer patients

Factors affecting parametrial involvement in cervical cancer patients with tumor size ≤4 cm and selection of low-risk patient group

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