Reproductive and obstetric outcomes after radical abdominal trachelectomy for early-stage cervical cancer in a series of 31 pregnancies

Abstract

Prospective multicenter studies are needed to determine if the results shown in this retrospective cohort can be generalized to all patients with early-stage cervical cancer who wish to undergo the fertility-sparing RAT procedure.

Laparoscopic Transabdominal Cerclage: Successful Term Pregnancy Following Radical Trachelectomy

“…In a study of patients undergoing abdominal trachelectomy, only 36.2% of patients subsequently conceived. 4 In women who conceive following trachelectomy, pregnancy may be associated with adverse outcomes, most notably preterm delivery. In a review of 200 pregnancies after radical trachelectomy, Jolley et al showed that 9.5% (19/ 200) pregnancies ended in second-trimester miscarriages.…”

Nerve-sparing abdominal radical trachelectomy: a novel concept to preserve uterine branches of pelvic nerves

“…It is known that radical vaginal trachelectomy has better reproductive outcomes than abdominal trachelectomy [3,[6][7][8][9]. The mechanistic reasons for this superiority remain unclear, but less invasive approaches preserving much more tissue and nerves around the cervix may contribute.…”

“…Patients with FIGO stage Ia2-Ib1 with small tumor size (less than 2 cm in diameter) without retroperitoneal lymph node metastases have been likely to undergo this operation, and the oncologic outcomes have been reported to be satisfactory, comparable with radical hysterectomy [3][4][5]. However, the reproductive outcomes of this operation appear insufficient, and some reports indicated that radical vaginal trachelectomy, rather than abdominal trachelectomy, shows more favorable reproductive outcomes [3,[6][7][8][9], while the oncologic outcomes of vaginal trachelectomy appeared to be inferior to those of the abdominal procedure, especially in patients with tumors larger than 2 cm [8,[10][11][12]. The precise cause of the relatively poor reproductive outcomes of abdominal radical trachelectomy remains unclear, but it is possible that disruption of autonomic nerves that innervate the uterine Objectives: Nerve-sparing techniques to avoid bladder dysfunction in abdominal radical hysterectomy have been established during the past two decades, and they have been applied to radical trachelectomy.…”

Preconception preparation (cerclage) after radical cervical surgery

“…Несколько большая частота наступления беременностей отмечена в исследо-вании H. Nishio и соавт. [4], в котором авторы, исследуя исходы 114 РАТ, выявили, что беременность наступила у 25 (21,9%) пациенток, однако из 11 469 женщин планиро-вали беременность. Таким образом, частота наступления беременности в данном исследовании составила 36,2%.…”

“…В исследовании Японских авторов [4], изучавших от-даленные результаты РАТ, было отмечено, что беремен-ность наступила у 25 (36,2%) из 69 пациенток, желавших реализовать репродуктивную функцию. Из 25 пациенток у 4 (16%) беременность прервалась в I триместре.…”