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

Abstract

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.

Effect of Low-Frequency Electric Pulse Technique Combined with Carboprost Methylate Suppositories on Recovery of Gastrointestinal Function and Postoperative Complications of Patients with Scarred Uterus Undergoing Secondary Cesarean Section

“…C-section refers to the operation for women whose gestation time is more than 28 weeks to remove the fetus and its appendages through laparotomy and cutting the uterus. e operation rate of C-section specified by the World Health Organization is less than 15%, but with the continuous progress of perinatology, it is increasing year by year worldwide, which is about 20% in European and American countries and more than 30% in China [15][16][17]. C-section can reduce the pain caused by contractions and delivery and is beneficial to protect the safety of the fetus due to the short operation time, so its operation rate is difficult to reduce in the clinic.…”

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

“…Pregnancy after RT itself has an extremely high risk of preterm birth [6,9,10]. As is well known, the uterine cervix works not only as a mechanical support of the fetus but also as a barrier against intrauterine infection [11].…”

“…Of course, there were no differences of the management methods between patients who underwent RT during pregnancy and those who underwent RT before pregnancy. Follow-up of pregnant patients after vaginal RT was performed according to a protocol described previously [6]. We recommend that patients enter hospitalization early in the second trimester of the pregnancy even if there are no signs of threatened abortion.…”

“…Recently radical trachelectomy (RT) with pelvic lymphadenectomy, originally proposed by Dargent et al in 1988 [5], has become a new treatment option for young patients who desire the preservation of their fertility. As we reported before, we have already performed vaginal radical trachelectomy (RT) for 73 patients with early invasive uterine cervical cancer [6].…”

Early Cervical Lesions Affecting Ovarian Reserve and Reproductive Outcomes of Females in Assisted Reproductive Cycles

“…A case-control study showed a 2-fold increase in risk of infertility for women after CIN treatments compared with untreated women ( 6 ), while other studies involving larger samples demonstrated no evident adverse effects of CIN history and treatments on fertility ( 7 , 8 ). As for early invasive cervical cancer, previous studies mainly focused on obstetric outcomes following different-type surgeries, such as abdominal, vaginal, or robot-assisted radical trachelectomy, aiming to prove the feasibility and safety of surgeries ( 9 – 12 ). Generally, most studies indicated that no significant negative effect of ECL and related surgical treatment on female fertility was observed.…”