PPO.47 Radical Vaginal Trachelectomy for Cervical Cancer during pregnancy and subsequent obstetric outcome

Abstract

Radical Vaginal Trachelectomy (RVT) is a fertility sparing technique first described by D’Argent in 1994.1 This involves removal of the cervix and parametrial tissue, laparoscopic bilateral pelvic lymph node dissection (LND), and insertion of isthmic cerclage suture. Subsequent or continuing pregnancy management is challenging.2,3 We describe the case of a 27 year old woman, Para1, with a smear noting severe dyskaryosis. Large loop excision of the transformation zone (LLETZ) noted cervical intra-epithelial neoplasia (CIN) 3 and multiple foci of early invasive Squamous Cell Carcinoma. Magnetic Resonance Imaging (MRI) noted no lymphadenopathy, giving FIGO Stage 1b1. Pre-operative bloods noted a positive BHCG, and a 5-week gestational sac was detected on subsequent ultrasound scan (USS). Options were discussed and she chose modified RVT and pelvic LND at 10 weeks. Histology returned clear. She had regular USS for cervical length and fetal growth, which remained normal. A low vaginal swab was taken, and prophylactic antibiotics given every 4 weeks, with steroids at 32 weeks. She underwent elective caesarean section at 35+5 weeks via Pfannenstiel and high transverse incisions. She delivered a healthy male infant, weighing 3230g, with normal apgars. A subsequent 3 day admission to Special Care Baby Unit (SCBU) occurred due to grunting and rash. She required cervical dilation and removal of cerclage on Day 3 postpartum, due to stenosis and endometrial collection. She was discharged on Day 6 and proceeded to laparoscopic hysterectomy and bilateral salpingo-oophorectomy 1 month later. Histology was negative and follow-up to date is clear. References D’Argent D, et al. Pregnancies following radical trachelectomy for invasive cervical cancer. Gynaecologic Oncology 1994;52:105 Shepherd JH, et al. Radical vaginal trachelectomy as a fertility-sparing procedure in women with early stage cervical cancer-cumulative pregnancy rate in a series of 123 women. British Journal of Obstet and Gyn 2006;113:719–724 Ungar L, et al. Abdominal radical trachelectomy during pregnancy to preserve pregnancy and fertility. Ostet Gynecol. 2006;Sep;108(3pt2):811–4