Oncological and Obstetric Results After Radical Trachelectomy as the Fertility-Sparing Therapy on Early-Stage (FIGO 2018 Stage IA2-IB3) Cervical Cancer Patients

Abstract Purpose To explore the oncological and obstetric results after radical trachelectomy in early-stage cervical cancer. Methods Retrospective analysis of the oncological and obstetric results to 23 patients with early cervical cancer (stage IA2-IB3; International Federation of Gynecology and Obstetrics 2018) accepting radical trachelectomy in The Maternal and Child Health Care Hospital of Guiyang from Oct 2004 to Sep 2018. Results Among those patients with tumor size＞4cm (up to 5cm) three patients who wished to preserve fertility accepted radical trachelectomy after neoadjuvant chemotherapy. 23 patients had cervical tumors of the histological type squamous cell carcinoma (SCC). All of the patients retained reproductive function. The mean time of the follow-up was 112.87±55.75months(36-199months). The median tumor size was 2.00±1.35cm (invisible by eyes-5.00cm). No occurred recurrence in any of the cases. Pregnancy outcomes are described as follows: 17 cases attempted to pregnancy, in which 8 cases (47.06%) conceived 12 times. First-trimester abortion and voluntary abandonment of pregnancy occurred in 4 cases (33.33%) respectively, one among patients who choose to abandon pregnancy being induced at 24 weeks of gestation. Second-trimester abortion occurred in3 cases (25.0%), and the reason for abortion was chorioamnionitis. Premature delivery at 32 weeks occurred once (8.33%). Conclusion Radical trachelectomy is a safe and effective treatment for young women with early-stage cervical cancer. Neoadjuvant chemotherapy and Radical trachelectomy provides the possibility of preserving pregnant ability for patients with cervical tumor＞4cm. However, it is worth further exploration.

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Fertility-Sparing Surgery In Early Stage Cervical Cancer

Indonesian Journal of Cancer ◽

10.33371/ijoc.v12i1.553 ◽

2018 ◽

Vol 12 (1) ◽

pp. 37

Author(s):

IN Gede Budiana ◽

Tjokorda Gede Astawa Pemayun

Keyword(s):

Cervical Cancer ◽

Neoadjuvant Chemotherapy ◽

Early Stage ◽

Reproductive Function ◽

Reproductive Age ◽

Radical Trachelectomy ◽

Fertility Sparing Surgery ◽

Younger Age ◽

Fertility Sparing ◽

Early Stage Cervical Cancer

Cervical cancer is a malignancy in women that cause major impacts, not only biologically, but also in various aspects of life. On patients during reproductive age, cervical cancer poses severe sexual and reproductive debilitation. Trend in the onset of first diagnosis is moving towards younger age, and mostly affect women in their reproductive age. This would give a bad impact on the sustainability of the patient’s reproductive function. Until now, fertilitysparing approach for the management of early-stage cervical cancer is still rare in Indonesia. However, some options of conservative surgical therapy are available for patients who desire fertility, namely conization, simple tracellectomy, radical trachelectomy, and also neoadjuvant chemotherapy. These options have been proven effective and safe, while maintaining patients’ reproductive functions. ABSTRAKKanker serviks merupakan suatu penyakit keganasan pada wanita yang memiliki dampak luas, tidak hanya pada tubuh penderita, namun juga berbagai aspek kehidupan penderita. Pada penderita di usia reproduktif, kanker serviks menimbulkan masalah seksual dan reproduksi yang berat bagi penderita. Kini usia dimana terjadinya kanker serviks mulai menunjukkan kecenderungan yang semakin muda yang tentunya memberikan dampak buruk terhadap keberlangsungan fungsi reproduksi pasien. Hingga saat ini, tatalaksana kanker serviks stadium awal dengan pendekatan fertility-sparing masih jarang dilakukan di Indonesia. Namun, beberapa pilihan terapi bedah konservatif tersedia bagi pasien yang menginginkan fertilitas, yakni konisasi, trakelektomi sederhana, trakelektomi radikal. hingga pemberian kemoterapi neo-adjuvant. Pilihan terapi ini telah terbukti efektif dan aman, serta mampu mem pertahankan fungsi reproduksi pasien.

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Outcomes of Fertility-Sparing Radical Trachelectomy in Early-Stage Cervical Cancer

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2010.08.101 ◽

2010 ◽

Vol 17 (6) ◽

pp. S6

Author(s):

M.K. Kim ◽

C.H. Choi ◽

T. Song ◽

H.S. Park ◽

Y-Y. Lee ◽

...

Keyword(s):

Cervical Cancer ◽

Early Stage ◽

Radical Trachelectomy ◽

Fertility Sparing ◽

Early Stage Cervical Cancer

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Radical trachelectomy

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001782 ◽

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.

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Abdominal Radical Trachelectomy as a Fertility-Sparing Procedure in Women With Early Stage Cervical Cancer in a Series of 61 Women

Obstetrical & Gynecological Survey ◽

10.1097/ogx.0b013e3181c87c0f ◽

2010 ◽

Vol 65 (1) ◽

pp. 19-20

Author(s):

Hiroshi Nishio ◽

Takuma Fujii ◽

Kaori Kameyama ◽

Nobuyuki Susumu ◽

Masaru Nakamura ◽

...

Keyword(s):

Cervical Cancer ◽

Early Stage ◽

Radical Trachelectomy ◽

Fertility Sparing ◽

Early Stage Cervical Cancer

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Abdominal radical trachelectomy as a fertility-sparing procedure in women with early-stage cervical cancer in a series of 61 women

Gynecologic Oncology ◽

10.1016/j.ygyno.2009.06.036 ◽

2009 ◽

Vol 115 (1) ◽

pp. 51-55 ◽

Cited By ~ 88

Author(s):

Hiroshi Nishio ◽

Takuma Fujii ◽

Kaori Kameyama ◽

Nobuyuki Susumu ◽

Masaru Nakamura ◽

...

Keyword(s):

Cervical Cancer ◽

Early Stage ◽

Radical Trachelectomy ◽

Fertility Sparing ◽

Early Stage Cervical Cancer

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Early cervical cancer recurred with uterine fundus metastasis after laparoscopic fertility-sparing surgery: A case report

10.21203/rs.3.rs-32297/v2 ◽

2020 ◽

Author(s):

yuanming shen ◽

Xiaoyun Wan ◽

Jihong Liu ◽

Xing Xie

Keyword(s):

Cervical Cancer ◽

Minimally Invasive ◽

Squamous Cell ◽

Radical Hysterectomy ◽

Early Stage ◽

Radical Trachelectomy ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Early Stage Cervical Cancer ◽

Uterine Fundus

Abstract Purpose: Recently, the safety of minimally invasive radical hysterectomy for cervical cancer caused widespread controversy. The value of minimally invasive fertility-sparing surgery for early stage cervical cancer is still lacking evidence of randomized controlled trial (RCT).Methods: Here we present a case of stage IB3 (FIGO2018) cervical carcinoma undergone neoadjuvant chemotherapy plus laparoscopic radical trachelectomy (A clinical trial NCT02624531) because of strongly desiring to preserve the fertility. Nine months after the initial treatment, the patient was presented with a uterine fundus mass and elevated serum squamous cell antigen (SCC Ag) and OC125 antigen (CA125).Results: Cervical cancer uterine fundus involvement may occur with advanced tumor stage. Early stage cervical cancer relapsed with a uterine fundus metastasis after laparoscopic radical trachelectomy is exceptionally rare. The patient was treated and cured by a radical hysterectomy. Post-operative pathology confirmed an isolated implanted squamous cell carcinoma in uterine fundus and no previous surgical margins and endometria were involved.Conclusions: This firstly reported case indicates that the safety of laparoscopic radical trachelectomy is still uncertain for advanced stage cervical cancer even if neoadjuvant and post-surgery chemotherapy is given, and also suggests that it is needed to discuss carefully the benefit and risk of such a strategy with the patient when the fertility preservation is considered.

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Early cervical cancer recurred with uterine fundus metastasis after laparoscopic fertility-sparing surgery: A case report

10.21203/rs.3.rs-32297/v1 ◽

2020 ◽

Author(s):

Yuanming Shen ◽

Xiaoyun Wan ◽

Jihong Liu ◽

Xing Xie

Keyword(s):

Cervical Cancer ◽

Minimally Invasive ◽

Squamous Cell ◽

Early Stage ◽

Advanced Tumor Stage ◽

Radical Trachelectomy ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Early Stage Cervical Cancer ◽

Uterine Fundus

Abstract Purpose Recently, the safety of minimally invasive radical hysterectomy for cervical cancer caused widespread controversy.The value of minimally invasive fertility-sparing surgery for early stage cervical cancer is still lacking evidence of randomized controlled trial (RCT). Methods Here we present a case of stage IB3 (FIGO2018) cervical carcinoma undergone neoadjuvant chemotherapy plus laparoscopic radical trachelectomy (A clinical trial NCT02624531) because of strongly desiring to preserve the fertility. Nine months after the initial treatment, the patient was presented with an uterine fundus mass and elevated serum squamous cell antigen (SCC Ag) and OC125 antigen (CA125). Results Cervical cancer uterine fundus involvement may occur with advanced tumor stage. Early stage cervical cancer relapsed with an uterine fundus metastasis after laparoscopic radical trachelectomy is exceptionally rare. The patient was treated and cured by a radical hysterectomy.Post-operative pathology confirmed an isolated implanted squamous cell carcinoma in uterine fundus and no previous surgerical margins and endometria were involved. Conclusions This firstly reported case indicates that the safety of laparoscopic radical trachelectomy is still uncertain for advanced stage cervical cancer even if neoadjuvant and post-surgery chemotherapy is given, and also suggests that it is needed to discuss carefully the benefit and risk of such a strategy with the patient when the fertility preservation is considered.

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