An update of oncologic and obstetric outcomes after abdominal trachelectomy using the FIGO 2018 staging system for cervical cancer: a single-institution retrospective analysis

Abstract

Objective To apply the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system to all patients who underwent trachelectomy in our previous study and to update the oncologic and obstetric results. Methods We retrospectively reviewed the medical records of patients in whom abdominal trachelectomy was attempted between June 2005 and September 2021. The FIGO 2018 staging system for cervical cancer was applied to all patients. Results Abdominal trachelectomy was attempted for 265 patients. Trachelectomy was converted to hysterectomy in 35 patients, and trachelectomy was completed successfully in 230 (conversion rate: 13%). Applying the FIGO 2018 staging system, 40% of the patients who underwent radical trachelectomy had stage IA tumors. Among 71 patients who had tumors measuring ≥2 cm, 8 patients were classified as stage IA1 and 14 as stage IA2. Overall recurrence and mortality rates were 2.2% and 1.3%, respectively. One hundred twelve patients attempted to conceive after trachelectomy; 69 pregnancies were achieved in 46 patients (pregnancy rate: 41%). Twenty-three pregnancies ended in first-trimester miscarriage, and 41 infants were delivered between gestational weeks 23 and 37; 16 were deliveries at term (39%) and 25 were premature deliveries (61%). Conclusion This study suggested that patients judged to be ineligible for trachelectomy and patients receiving overtreatment will continue to appear using the current standard eligibility criteria. With the revisions to the FIGO 2018 staging system, the preoperative eligibility criteria for trachelectomy, which were based on the FIGO 2009 staging system and tumor size, should be changed.

Pregnancy outcomes following radical trachelectomy for early‐stage cervical cancer: A retrospective observational study in the Kanto area, Japan

“…Although obstetric management was performed according to the Japanese Society of Obstetrics and Gynecology in each institution, 12 the management of pregnancies after RT was different for each institution. The methodology of RT was described in previous reports 9,13–17 . According to previous reports, many institutions decided how much cervix was removed using frozen section and ensured a residual cervical length (CL) >10 to 20 mm.…”

“…The methodology of RT was described in previous reports. 9,[13][14][15][16][17] According to previous reports, many institutions decided how much cervix was removed using frozen section and ensured a residual cervical length (CL) >10 to 20 mm. Data are presented as median (range) or number of cases (percentage).…”

“…Reports suggest that preterm delivery due to preterm premature rupture of membrane (PROM) and abnormal bleeding from the varices at the site of uterovaginal anastomosis are important considerations in pregnancy following RT. [7][8][9][10] Although we reviewed pregnancy management after RT, it has not yet been shown to prevent preterm delivery, and many clinicians are trying to prevent adverse outcomes. 11 In Japan, RT as a treatment modality for women with early-stage cervical cancer, is gaining popularity.…”