Possibility of less radical treatment for patients with early invasive uterine cervical cancer

BMC Pregnancy Childbirth

Mariya

et al. 2020

Self Cite

Background: Radical tracheletomy (RT) with pelvic lymphadenectomy has become an option for young patients with early invasive uterine cervical cancer who desire to maintain their fertility. However, this operative method entails a high risk for the following pregnancy due to its radicality. Methods: We have performed vaginal RT for 71 patients and have experienced 28 pregnancies in 21 patients. They were followed up carefully according to the follow-up methods we reported previously. Their pregnancy courses and prognoses after the pregnancy were retrospectively reviewed. Results: All the vaginal RTs were performed safely without serious complications, including 6 patients who underwent the operation during pregnancy. The median time to be pregnant after RT was 29.5 months. 13 patients (46%) became pregnant without artificial insemination by husband or assisted reproductive technology. Cesarean section was performed for all of them. The median time of pregnancy was 34 weeks, and emergent cesarean section was performed for 7 pregnancies (25%). The median birth weight was 2156 g. Four patients had trouble with cervical cerclage, and they suffered from sudden premature preterm rupture of the membrane (pPROM) during the second trimester of pregnancy. We underwent transabdominal cerclage (TAC) for all of them and careful management for the prevention of uterine infection was performed. One patient had a recurrence of cancer during pregnancy. Conclusions: Both the obstetrical prognosis and oncological prognosis after vaginal RT have become favorable for pregnant patients after vaginal RT.

Section: Discussionsupporting

confidence: 54%

Pregnancies after vaginal radical trachelectomy (RT) in patients with early invasive uterine cervical cancer: results from a single institute

Shinkai

BMC Pregnancy Childbirth

Mariya

et al. 2020

Self Cite

“…As we reported recently, more conservative vaginal RT might be possible in patients with stage 1B1 or less without affecting the oncological prognosis. Especially in patients with stage 1A2, simple trachelectomy might be possible …”

Section: Discussionmentioning

confidence: 99%

“…Especially in patients with stage 1A2, simple trachelectomy might be possible. 16 RT during pregnancy might still be an experimental treatment modality. In addition, obstetrical management after RT is also very difficult.…”

Section: Discussionmentioning

confidence: 99%

Obstetrical prognosis of patients who underwent vaginal radical trachelectomy during pregnancy

Umemoto

J of Obstet and Gynaecol

Mizugaki

et al. 2019

Self Cite

Aim Radical trachelectomy (RT) with pelvic lymphadenectomy has become an option for young patients with early invasive uterine cervical cancer who decide to maintain their fertility. However, this operative method entails a high risk for the following pregnancy due to its radicality. Therefore, RT for pregnant patients can be a challenge both for gynecologic oncologists and obstetricians. Methods We have performed vaginal RT for five pregnant patients with uterine cervical cancer stage 1B1 according to the method of Dargent et al. The operations were performed between 16 and 26 weeks of pregnancy, and the patients were followed up carefully according to the follow‐up methods we reported previously. Results Vaginal RT was performed for five patients without any troubles. Four of the patients continued their pregnancies until almost 34 weeks or longer under our previously published follow‐up schedule. The pregnancy of one patient was terminated at 26 weeks due to recurrence of the cancer. Conclusion Expansion of vaginal RT for pregnant patients with uterine cervical cancer could be a practical option for pregnant patients with early invasive uterine cervical cancer.

“…However, vaginal RT is a more conservative operation than abdominal RT. Vaginal RT resects the parametrium at the level of type II hysterectomy, whereas abdominal RT can provide wider resection up to the level of type III resection [22]. Does such a conservative procedure of vaginal RT affect the recurrence of the cancer?…”

Section: Discussionmentioning

confidence: 99%

Does radical trachelectomy (RT) during pregnancy have higher obstetrical and oncological risks than RT before pregnancy?

Shinkai

Mariya

et al. 2022

Arch Gynecol Obstet

Radical trachelectomy (RT) with pelvic lymphadenectomy has become a new treatment option for young patients with uterine cervical cancer stages 1A2-1B1 who desire the preservation of their fertility. However, the application of RT for pregnant patients is still controversial. We comparatively studied both obstetrical and oncological outcomes of pregnant patients who underwent vaginal RT during pregnancy and those who underwent vaginal RT before pregnancy. MethodsBoth obstetrical and oncological results of eight patients who underwent vaginal RT with pelvic lymphadenectomy during pregnancy in our institute between 2010 and 2020 (Group A), and ten pregnant patients who underwent vaginal RT with pelvic lymphadenectomy before pregnancy during the same period (Group B) were reviewed based on their medical charts. ResultsThere were no signi cant differences in blood loss, surgical time, or surgical completeness between Group A and Group B.Nor were there signi cant differences in obstetrical outcomes between the two groups. However, two of the eight patients in Group A had recurrence of the cancer. None of the patients in Group B has shown any signs of recurrence thus far. ConclusionVaginal RT during pregnancy does not affect the obstetrical prognoses of patients with early invasive uterine cervical cancer, and it might be a tolerable treatment modality for them. However, oncologically, it should be performed carefully as there is a risk of recurrence.