Trachelectomy during pregnancy: What has experience taught us?

Abstract

The treatment of early stage cervical malignancy in a pregnant patient remains a challenge. We report the successful application of a vaginal radical trachelectomy (VRT) during pregnancy to treat a patient diagnosed with early stage cervical cancer and subsequently review the published work. A 22-year-old female diagnosed at the gestational age of 17 weeks with International Federation of Gynecology and Obstetrics stage IB1 squamous cell cervical carcinoma was treated with VRT at 19(+5) weeks. At 36 weeks, the patient underwent a scheduled cesarean section. A healthy male infant was delivered with a weight of 2795 g. After 13 months of follow-up, the patient is doing well with no evidence of recurrent disease.

Cervical Cancer Associated with Pregnancy: Current Challenges and Future Strategies

“…From an oncological point of view, a systematic review totaling more than 600 cases confirmed an overall recurrence rate < 5% and a death rate < 3%, demonstrating the safety of this approach for small invasive cervical tumors [55]. RT in pregnancy has been investigated by many teams, as first-line therapy for patients diagnosed with tumors <2 cm (≤IB1 according to FIGO 2018) [33,[56][57][58][59][60][61][62][63][64][65][66] or, in rarer situations, for patients diagnosed with tumors >2 cm (≥IB2 according to FIGO 2018) [67][68][69][70][71][72][73][74][75]. RT can be performed either through abdominal [58][59][60]63,66,67,69,72,74,76] or vaginal approach (Dargent's method) [56,57,61,71,73,75,77,78], each technique being associated with its own advantages and drawbacks.…”

“…RT in pregnancy has been investigated by many teams, as first-line therapy for patients diagnosed with tumors <2 cm (≤IB1 according to FIGO 2018) [33,[56][57][58][59][60][61][62][63][64][65][66] or, in rarer situations, for patients diagnosed with tumors >2 cm (≥IB2 according to FIGO 2018) [67][68][69][70][71][72][73][74][75]. RT can be performed either through abdominal [58][59][60]63,66,67,69,72,74,76] or vaginal approach (Dargent's method) [56,57,61,71,73,75,77,78], each technique being associated with its own advantages and drawbacks. Vaginal approach allows for less manipulation of the pregnant uterus and thus may carry a lower risk of spontaneous abortion.…”

“…Cesarean-Radical Hysterectomy (CRH) vs. Delayed Radical Hysterectomy (RH) CRH was the preferred modality of surgical therapy across studies [56,59,68,. Its main indications were residual disease after radical trachelectomy, IB1 tumors in patients who do not wish to undergo fertility-preservation surgery, or for IB2-3 tumors after neoadjuvant chemotherapy (Figure 2).…”