scholarly journals Large Conization—Retrospective Monocentric Results for Fertility Preservation in Young Women with Early Stage Cervical Cancer

2021 ◽  
Author(s):  
Christos Tsaousidis ◽  
Bernhard Kraemer ◽  
Stefan Kommoss ◽  
Andreas Hartkopf ◽  
Sara Brucker ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Young Women ◽  
Early Stage ◽  
Resection Margins ◽  
Obstetric Outcomes ◽  
Safe Alternative ◽  
Fertility Sparing ◽  
Early Stage Cervical Cancer ◽  
Cervical Segment ◽  
Associated Risk Factors

Abstract  The shorter cervical segment after classic radical trachelectomy (RT) imposes a number of pregnancy associated risk factors. In this aspect, large conization (LC) could be an oncologically safe alternative to RT in young women with early stage cervical cancer who want to spare their fertility. Our aim was to evaluate fertility-sparing surgical treatment of early stage cervical cancer after the introduction of LC. Our objectives were to assess surgical, oncological, fertility and obstetric outcomes. We retrospectively investigated oncological and fertility outcomes of patients who underwent LC in a large oncological single University centre between 2009 and 2014. Medical records were reviewed and analysed for surgical, oncological, fertility and obstetric outcomes. Postal questionnaires were collected to further evaluate and validate the fertility and obstetric outcomes. A total of 23 LCs were analysed. Seven patients had to undergo secondary radical hysterectomy after LC due to unclear resection margins. Nine of 16 women tried to conceive, of which all nine became pregnant. Seven patients underwent a prophylactic cerclage between 13 and 16 gestational weeks and seven women delivered 9 children; the majority of women conceived spontaneously. Follow-up time was a median of 3.9 years (2.6–8 years). There was no relapse of cervical cancer in the investigated timeframe. Early stage cervical cancers treated by LC are associated with excellent oncological outcomes. LC appears to be a safe option for eligible women who intend to maintain their fertility.

Radical trachelectomy

2021 ◽  
pp. ijgc-2020-001782
Author(s):  
Blanca Segarra-Vidal ◽  
Jan Persson ◽  
Henrik Falconer
Keyword(s):  
Cervical Cancer ◽  
Multidisciplinary Approach ◽  
Early Stage ◽  
Obstetric Outcomes ◽  
Radical Trachelectomy ◽  
Local Resources ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing ◽  
Early Stage Cervical Cancer ◽  
Prospective Trials

Radical trachelectomy is the ‘cornerstone’ of fertility-sparing surgery in patients with early-stage cervical cancer wishing to preserve fertility. Growing evidence has demonstrated the oncologic safety and subsequent favorable pregnancy outcomes in well-selected cases. In the absence of prospective trials, the decision on the appropriate surgical approach (vaginal, open, or minimally invasive surgery) should be based on local resources and surgeons’ preferences. Radical trachelectomy has the potential to preserve fertility in a large proportion of women with early-stage cervical cancer. However, prematurity and premature rupture of membranes are common obstetric complications after radical trachelectomy for cervical cancer. A multidisciplinary approach is crucial to optimize the balance between oncologic and obstetric outcomes. The purpose of this review is to provide an updated overview of the technical, oncologic, and obstetric aspects of radical trachelectomy.

scholarly journals Trends in Use and Survival Associated With Fertility-Sparing Trachelectomy for Young Women With Early-Stage Cervical Cancer

2018 ◽  
Vol 131 (6) ◽  
pp. 1085-1094 ◽  
Author(s):  
Rosa R. Cui ◽  
Ling Chen ◽  
Ana I. Tergas ◽  
June Y. Hou ◽  
Caryn M. St. Clair ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Young Women ◽  
Early Stage ◽  
Fertility Sparing ◽  
Early Stage Cervical Cancer

scholarly journals The Conundrum of Prematurity and Pregnancy Outcomes after Fertility Sparing Treatment Modalities for Early Stage Cervical Cancer:  A Systematic Review of the Literature

Folia Medica ◽  
2020 ◽  
Vol 62 (3) ◽  
pp. 453-461
Author(s):  
Anastasios Pandraklakis ◽  
Nikolaos Thomakos ◽  
Anastasia Prodromidou ◽  
Maria D. Oikonomou ◽  
IoannisIoannis G. Papanikolaou ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Preterm Births ◽  
Modern Medicine ◽  
Cervical Length ◽  
Current Evidence ◽  
Obstetric Outcomes ◽  
Review Of The Literature ◽  
Fertility Sparing ◽  
Early Stage Cervical Cancer

Advances in modern medicine have allowed patients with early stage cervical cancer (stages Ia - IIai) to preserve their fertility with oncologic efficacy comparable to previous radical treatments. A variety of conservative-fertility sparing procedures, also known as Fertility Sparing Surgeries (FSS) have been proposed. The present review aimed to provide the current evidence on obstetric outcomes and the prematurity rates as well as to discuss the management modalities of these high-risk pregnancies. Our review of the literature included 3042 women with early cervical cancer, of whom 2838 underwent FSS (204 excluded for oncologic reasons). Almost half of these patients attempted to become pregnant and about two thirds of them achieved at least one pregnancy either spontaneously or with the help of Assisted Reproduction Technologies. Data revealed that 63.9% of these pregnancies resulted in live births, whereas 37.6% of them were preterm. The main cause of preterm births in this subpopulation is the postoperative cervical length restriction that consequently leads to cervical incompetence and ascending infections that eventually lead to (clinical or subclinical) chorioamnionitis. Radical operations such as ART, VRT and MIRT presented with higher prematurity rates. The lack of standardized protocols for the management of pregnancies after FSS precluded reaching to firm results with regards to the efficacy of them in achieving favourable obstetrical outcomes. Further large volume studies are warranted with the intent to acquire standardized guidelines for pregnancies achieved after FSS for early stage cervical cancer.

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