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

Abstract

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.

Reproductive and Obstetric Outcomes after Fertility-Sparing Treatments for Cervical Cancer: Current Approach and Future Directions

“…Although the available fertility-sparing management procedures for patients with cervical cancer may achieve satisfactory results, there are potential complications related to these procedures such as cervical stenosis, vaginal bleeding from cervical vessels, and complications associated with the shortened cervix (spontaneous abortion, chorioamnionitis, PPROM, and preterm births) [ 51 , 52 , 53 , 54 , 55 ].…”

Outcomes of fertility treatment after radical trachelectomy for early stage cervical cancer

“…RT has been reported to be non-inferior to RH in terms of disease-free and overall survivals [6]. In terms of obstetric outcomes, the pregnancy rate following RT has been reported to be favorable, with various conception rates [7].…”

“…Di culties in achieving pregnancy following RT have been described as post-RT infertility [6], decreased ovarian reserve [8], pregnancy rate per embryo transfer (ET) [9], cervical stenosis, bleeding from the cervix, and shortened cervix associated with pregnancy complications such as miscarriage, chorioamnionitis, preterm premature rupture of membrane (pPROM), and preterm delivery [7,10]. When natural conception is di cult or infertility is caused by cervical factors, treatment, including in vitro fertilization (IVF), is often required after RT.…”