Cerclage during trachelectomy for early-stage cervical cancer

Abstract

Low-grade endometrial endometrioid adenocarcinomas (LGEECa) can recur in the vagina (VRec), pelvic and abdominal region (PARec), or distant sites (DMet). Tumor size, histopathologic features, and lymph node involvement at presentation have been linked to the development of these recurrences. However, the amount of information on risk factors to predict site of recurrence is limited. Methods: In this multi-institutional study, we analyzed data from 589 patients with FIGO grades 1 and 2 LGEECa and found 116 patients with VRec, PARec, or DMet. They were compared with 187 age-matched controls with negative lymph nodes, no adjuvant treatment, and no recurrences; mean follow-up times were 44 and 59 months, respectively. Cox proportional hazards analysis was used to identify univariable and multivariable risk factors for each type of recurrence (P b .05).Results: Forty-one patients had VRec, 33 had PARec (pelvic soft tissue, 14; abdominal tissue, 9; liver capsule, 5; retroperitoneum, 3; colorectal wall, 2), and 42 had DMet (lung, 19; lymph nodes, 17; bone and soft tissue, 5; brain, 1) as the initial site of recurrence. Univariate and multivariate analysis of histopathologic features are summarized in Table 1. In addition, features associated with vaginaonly recurrence included superficial myometrial invasion (P = .002); low nuclear grade (P = .03); lymphovascular invasion (LVI) adjacent to tumor, but not deeper than invasive tumor front (P b .001); less than 5% microcystic elongated and fragmented pattern (MELF) at invasive tumor front (P = .014); and no pelvic lymph node metastasis at presentation (P = .019). These features were not significantly different from controls. Conclusions: (1) Features of LGEECa that predicted VRec included superficialy invasive, low nuclear grade tumors with minimal MELF, minimal or no LVI, and no lymph node metastasis. These features were more closely related with tumors that did not recur than with recurrent tumors. (2) LGEECa with PARec differed from those with VRec, because the tumors were larger and deeply invasive and MELF at invasive tumor front, suggesting a different dissemination route than tumors with VRec. (3) Significant predictor features of LGEECa with DMet included intraglandular tumor necrosis, cell clusters at the invasive front and adjacent to areas of LVI, and cervical stromal involvement. The latter feature might be indicative of venous rather of lymphatic invasion.

Announcement of First Successfully Pregnancy Following Abdominal Radical Trachelectomy in Viet Nam

“…However, ESGO guideline in 2018 recommended to place cerclage routinely when performing ART [14]. According to on survey of SGO members showed that 66% of surgeons agreed to place cerclage after ART [15]. All patients in our report were placed cerclage base on ESGO guideline.…”

Fertility-sparing surgery: a hopeful strategy for young women with cancer

“…If cervical cancer is diagnosed in the first trimester of pregnancy, patients should be properly counseled about the risk of continuing the pregnancy and the appropriate cancer treatment so as not to compromise either the maternal or fetal prognosis [ 51 ]. The intraoperative cerclage placed transabdominal either during FSS or subsequent pregnancy is a decision that must be made according to the patient's obstetrical history because performing a simple trachelectomy does not routinely require this procedure [ 52 , 53 ]. Performing Pap tests and/or colposcopy in patients with FSS in the first trimester in pregnant women is extremely important in diagnosing and monitoring these patients.…”

Laparoscopic Cerclage During Radical Trachelectomy—a Novel Technique: A Case Report and Review of the Literature

“…In June of 2016, the results of an electronic survey given to all Society of Gynecologic Oncology (SGO) members were published. 3 The survey had questions regarding cerclage placement during trachelectomy for early stage cervical cancer. Of a total of 1598 Society members, 121 responded.…”