Faculty Opinions recommendation of Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Cervical Cancer.

Author(s):  
Eva Chalas
2021 ◽  
pp. ijgc-2020-001782
Author(s):  
Blanca Segarra-Vidal ◽  
Jan Persson ◽  
Henrik Falconer

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.


Author(s):  
Chia-Yi Lee ◽  
Yu-Li Chen ◽  
Ying-Cheng Chiang ◽  
Ching-Yu Cheng ◽  
Yen-Ling Lai ◽  
...  

We aimed to investigate the outcomes and subsequent pregnancies of early-stage cervical cancer patients who received conservative fertility-sparing surgery. Women with early-stage cervical cancer who underwent conservative or fertility-sparing surgery in a tertiary medical center were reviewed from 2004 to 2017. Each patient’s clinicopathologic characteristics, adjuvant therapy, subsequent pregnancy, and outcome were recorded. There were 32 women recruited, including 12 stage IA1 patients and 20 stage IB1 patients. Twenty-two patients received conization/LEEP and the other 10 patients received radical trachelectomy. Two patients did not complete the definite treatment after fertility-sparing surgery. There were 11 women who had subsequent pregnancies and nine had at least one live birth. The live birth rate was 73.3% (11/15). We conclude that patients with early-stage cervical cancer who undergo fertility-sparing surgery can have a successful pregnancy and delivery. However, patients must receive a detailed consultation before surgery and undergo definitive treatment, if indicated, and regular postoperative surveillance.


2018 ◽  
Vol 12 (1) ◽  
pp. 37
Author(s):  
IN Gede Budiana ◽  
Tjokorda Gede Astawa Pemayun

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.


2020 ◽  
Author(s):  
yuanming shen ◽  
Xiaoyun Wan ◽  
Jihong Liu ◽  
Xing Xie

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.


2020 ◽  
Author(s):  
Yuanming Shen ◽  
Xiaoyun Wan ◽  
Jihong Liu ◽  
Xing Xie

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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