Obstetrical prognosis of patients who underwent vaginal radical trachelectomy during pregnancy

Abstract

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.

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

“…Our recurrence rate in pregnant women corresponded to the reports of 4.8% after vaginal RT by Plante et al [9], and 3.7% after abdominal RT by Li et al [13]. As we reported recently, expansion of vaginal RT even for pregnant patients is a practical option now [5]. We believe that operative procedures of vaginal RT for pregnant patients to remove the uterine cervix are more conservative and simpler than abdominal RT for them because vaginal RT makes it possible to cut the uterine cervix and the parametrium without laparotomy.…”

“…Radical trachelectomy (RT) with pelvic lymphadenectomy, originally reported by Dargent et al in 1988 [1], has become a new treatment option for young patients in Japan with early invasive uterine cervical cancer who desire preservation of their fertility [2][3][4]. This operative modality is recently performed even during pregnancy [5]. Recent data indicate that the oncologic results following RT are comparable to the results following standard radical hysterectomy (RH) [6][7][8].…”

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

“…Furthermore, RT is performed through either the abdominal or vaginal route. As we reported previously, vaginal RT for pregnant patients seems to have an advantage over abdominal RT in terms of the direct stress on the fetus in the uterus because vaginal RT does not need complicated intra-abdominal procedures [16]. Vaginal RT during pregnancy does not seem to affect the fetal condition as long as the operation is performed early in the second trimester of pregnancy before 20 weeks of pregnancy.…”

Invasive and in situ cervical cancer associated with pregnancy: analysis from the French cancer network (CALG: Cancer Associé à La Grossesse)

“…Physiologic changes, especially the presence of cervical edema related to pregnancy, might alter the clinical assessment of tumor size [23]and MRI can be safely performed during pregnancy not only to evaluate the initial FIGO stage but also to determine response to chemotherapy and hence to adapt therapy [21,22]. Moreover, patients with lesions under 2 cm are eligible for conization or simple trachelectomy (used in 21% of our population) which appears to be a safe and effective treatment during pregnancy [24][25][26].…”