Abstract
Background
Trachelectomy was developed as a fertility-sparing surgery for early-stage cervical cancer in patients of childbearing age. The purpose of this study is to evaluate oncologic and obstetric outcomes and complications after abdominal trachelectomy.
Methods
We began to perform abdominal trachelectomy in 2005. Our institutional review board approved this clinical study, and fully informed consent was obtained from each patient. The medical records of patients who underwent trachelectomy were retrospectively reviewed.
Results
We performed 151 abdominal trachelectomies (89 radical trachelectomies, 48 modified radical trachelectomies, and 14 simple trachelectomies). The median age of the patients was 33 years, and the median postoperative follow-up period was 61 months. Although one patient experienced recurrence at the preserved cervix, none died after treatment. A total of 61 patients attempted to conceive after trachelectomy, and 21 pregnancies were achieved in 15 women. Hence, the pregnancy rate among patients who attempted to conceive was 25%. Fifteen babies were delivered by cesarean section between gestational weeks 23 and 37. Six babies were delivered at term. Six cases of preterm premature rupture of the membranes occurred. Varices appeared around the uterovaginal anastomotic site in five patients.
Conclusions
Our data indicate that the oncologic outcome was excellent but infertility treatment was necessary to achieve the majority of conceptions. Additionally, preterm premature rupture of the membranes and premature delivery were frequently observed. An improved pregnancy rate and prevention of complications during pregnancy are issues that should be addressed in future studies.
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References
Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61:69–90
Dargent D, Martin X, Sacchetoni A et al (2000) Laparoscopic vaginal radical trachelectomy: a treatment to preserve the fertility of cervical carcinoma patients. Cancer 88:1877–1882
Marchiole P, Benchaib M, Buenerd A et al (2007) Oncological safety of laparoscopic-assisted vaginal radical trachelectomy (LARVT or Dargent’s operation): a comparative study with laparoscopic-assisted vaginal radical hysterectomy (LARVH). Gynecol Oncol 106:132–141
Smith JR, Boyle DC, Corless DJ et al (1997) Abdominal radical trachelectomy: a new surgical technique for the conservative management of cervical carcinoma. Br J Obstet Gynecol 104:1196–1200
Nishio H, Fujii T, Kameyama K et al (2009) Abdominal radical trachelectomy as a fertility-sparing procedure in women with early-stage cervical cancer in a series of 61 women. Gynecol Oncol 115:51–55
Nishio H, Fujii T, Sugiyama J et al (2013) Reproductive and obstetric outcomes after radical abdominal trachelectomy for early-stage cervical cancer in a series of 31 pregnancies. Hum Reprod 28:1793–1798
Plante M, Gregoire J, Renaud MC et al (2011) The vaginal radical trachelectomy: an update of a series of 125 cases and 106 pregnancies. Gynecol Oncol 121:290–297
Rob L, Skapa P, Robova H (2011) Fertility-sparing surgery in patients with cervical cancer. Lancet Oncol 12:192–200
Noyes N, Abu-Rustum NR, Ramirez PT et al (2009) Options in the management of fertility-related issues after radical trachelectomy in patients with early cervical cancer. Gynecol Oncol 114:117–120
Ogawa S, Kobayashi H, Amada S et al (2010) Sentinel node detection with (99 m) Tc phytate alone is satisfactory for cervical cancer patients undergoing radical hysterectomy and pelvic lymphadenectomy. Int J Clin Oncol 15:52–58
Pareja R, Rendon GJ, Sanz-Lomana CM et al (2013) Surgical, oncological, and obstetrical outcomes after abdominal radical trachelectomy—a systematic literature review. Gynecol Oncol 131:77–82
Ribeiro Cubal AF, Ferreira Carvalho JI, Costa MF et al (2012) Fertility-sparing surgery for early-stage cervical cancer. Int J Surg Oncol. doi:10.1155/2012/936534
Xu L, Sun FQ, Wang ZH (2011) Radical trachelectomy versus radical hysterectomy for the treatment of early cervical cancer: a systematic review. Acta Obstet Gynecol Scand 90:1200–1209
Kasuga Y, Nishio H, Miyakoshi K et al (2016) Pregnancy outcomes after abdominal radical trachelectomy for early-stage cervical cancer: a 13-year experience in a single tertiary-care center. Int J Gynecol Cancer 26:163–168
Piver MS, Rutledge F, Smith JP (1974) Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol 44:265–272
Halaska MJ, Robova H, Pluta M et al (2015) The role of trachelectomy in cervical cancer. ecancermedicalscience. doi:10.3332/ecancer.2015.506
Li J, Li Z, Wang H et al (2011) Radical abdominal trachelectomy for cervical malignancies: surgical, oncological and fertility outcomes in 62 patients. Gynecol Oncol 121:565–570
Boss EA, van Golde RJ, Beerendonk CC et al (2005) Pregnancy after radical trachelectomy: a real option? Gynecol Oncol 99(Suppl 1):152–156
Gien LT, Covens A (2010) Fertility-sparing options for early stage cervical cancer. Gynecol Oncol 117:350–357
Acknowledgements
The authors thank Takako Yamane, Hironori Kenjo, Hiroshi Yagi, Tatsuhiro Ohgami, Masahumi Yasunaga, Tomoko Yoneda, Ichiro Onoyama, Akimasa Ichinoe, and Kazuo Asanoma for their technical assistance.
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Okugawa, K., Kobayashi, H., Sonoda, K. et al. Oncologic and obstetric outcomes and complications during pregnancy after fertility-sparing abdominal trachelectomy for cervical cancer: a retrospective review. Int J Clin Oncol 22, 340–346 (2017). https://doi.org/10.1007/s10147-016-1059-9
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DOI: https://doi.org/10.1007/s10147-016-1059-9