Radical abdominal trachelectomy and pelvic lymphadenectomy in a nulliparous patient with cervical adenocarcinoma: A case report (original) (raw)
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Gynecologic Oncology, 2009
Although vaginal radical trachelectomy is an effective treatment for early stage cervical cancer and has an acceptable live birth rate, there are concerns over its oncological safety and possible surgical injury with this radical procedure. Moreover, most gynecologists have difficulty performing this unfamiliar procedure and require special training. Many of these problems can be overcome with the use of abdominal radical trachelectomy. The abdominal approach provides adequate resection of the parametrial and vaginal tissue and does not require special training. Only a few case studies have investigated abdominal radical trachelectomy. This retrospective study presents follow-up data and reviews a series of cases conducted in Japanese women with early stage cervical cancer who had undergone elective abdominal radical trachelectomy and pelvic lymphadenectomy between 2002 and 2008. The aim of the study was to assess the effectiveness and safety of the abdominal approach in this population. A total of 61 patients at a median age of 33 years (range, 26-44 years) were followed up for a median 27 months (range, 1-67 months). There were 6 recurrences (9.8%, 6/61); 1 occurred in a patient with adenocarcinoma. None of the other 5 recurrences were found in cases with a primary tumor diameter of Ͻ20 mm. Twenty-nine (47.5%) of the 61 patients attempted to conceive and 4 (13.8%) were successful. Of the 4 live births, 2 were preterm, the remaining 2 were full term. The rates of serious intraoperative and postoperative complications were similar to those reported in the literature for standard radical hysterectomy and lymphadenectomy. The investigators conclude from these findings that an abdominal radical trachelectomy is an effective and relatively safe procedure in selected patients and may be an acceptable treatment option for young women with early stage cervical cancer.
Experimental and Therapeutic Medicine
The aim of this study was to present our experience of 18 cases of abdominal radical trachelectomy (ART), including 5 performed during pregnancy, analyzing patient selection, surgical complications, and oncological and obstetrical outcomes. This reproductive study included all early stage cervical cancer patients referred for ART at the 1st Obstetrics and Gynecology Clinic of the Emergency Clinical County Hospital Targu Mures, between 2010 and 2020. A total of 19 women were considered for ART, and only 1 case required conversion to radical hysterectomy. The patient mean age was 31 years (range 24-38 years), and 66.67% of the patients were nulliparous. Six women (33.33%) had stage IA2, 4 (22.22%) had stage IB1, 5 (27.78%) had stage IB2, and 4 (22.22%) had stage IB3 disease. One intraoperative complication occurred in this series, which consisted in both right ureteral and bladder injuries. Early postoperative complications were represented by urinary bladder dysfunction (33.33%), symptomatic pelvic lymphocele (11.1%), peritonitis (5.5%), and wound infection (5.5%). Late postoperative complications included cervical stenosis (5.5%), amenorrhea (11.1%), and pelvic abscess (5.5%). Four out of the 18 patients were operated on during pregnancy between 14 and 20 weeks; 2 of them gave birth at term, 2 of them aborted shortly after the surgery. Two vaginal recurrences were recorded; both were managed by hysterectomy, partial colpectomy and adjuvant chemoradiotherapy. At this moment, all patients are alive with no evidence of disease and 3 of them managed to conceive. In conclusion, ART should be recommended as a fertility-preserving procedure for women in their reproductive age. In selected cases, ART can be performed during pregnancy with encouraging results.
Abdominal Radical Trachelectomy as a Method of Preserving Fertility in Patients with Cervical Cancer
2018
Cervical cancer is the 4th most common type of cancer in women across EU. However, in women of reproductive age, the incidence of this pathology is high, therefore, over the last decades various strategies have been developed with the purpose of preserving fertility in oncological patients. This paper aimed at reviewing the existing literature information regarding the use of abdominal radical trachelectomy as a method of fertility sparing treatment for patients with early invasive cervical cancer injuries, without neglecting to emphasize on the surgical, obstetrical and oncological outcomes of this procedure.
Oncology Reports, 2013
Radical trachelectomy (RT) can be performed vaginally or abdominally (laparotomic, laparoscopic or robotic). The aim of this systematic review was to compare all techniques in terms of surgical complications, disease recurrence and subsequent fertility/pregnancy outcomes. A total of 1293 RTs were analyzed (FIGO-stage: IA1-IIA). The most frequent surgical complications do not differ from the ones of radical hysterectomy. The recurrence risk is approximately 3% (range 0-16.8%). The majority of women conceive spontaneously: 284 pregnancies with 173 live births. The most frequent pregnancy complication was miscarriage and chorioamnionitis. RT appears to be a safe option for eligible women who intend to maintain their future pregnancy desire.
Less Radical Surgery for Patient With Early-Stage Cervical Cancer
Iranian Red Crescent Medical Journal, 2013
Introduction: Surgery in cervical cancer should be used with intention of cure. Radical abdominal trachelectomy is a feasible operation for selected patients with stage Iα-1β cervical cancer which fertility can be preserved. Case Report: A 30-years-old woman with squamous cell cervical cancer stage (1 A II) diagnosed at September 2011 expressed a wish for fertility-sparing treatment. Radical abdominal hysterectomy and pelvic and para-aortic lymphadenectomy were performed which showed no evidence of lymphatic metastasis. Subsequently, at last follow-up (5 months post-surgery), good oncologic outcomes were found after this procedure. This was the first case of fertility-sparing radical trachelectomy procedures performed at our institution. Conclusions: Trachelectomy represents a valuable conservative surgical approach for early stage invasive cervical cancer.
Gynecological Surgery, 2008
Fertility-conserving surgical treatment of patients with early stage cervical cancer poses a particular challenge. In specialist centres, trachelectomy with laparoscopic lymphadenectomy could be established as a minimally invasive, fertilitypreserving alternative to radical hysterectomy for women of child-bearing age. This report describes the case of a 33-yearold patient who wished to conceive and was diagnosed with cervical cancer stage pT1a1 in 2004. The patient conceived 9 months after surgery and gave birth to a healthy baby girl at 38+0 weeks. Complications during pregnancy were gestational diabetes, premature contractions and pre-eclampsia at 37 weeks. The advantages and disadvantages of this method as well as the specific antenatal monitoring required are discussed. Keywords Trachelectomy. Cervical cancer. Fertility-conserving treatment Course of events Colposcopy The patient first presented in the dysplasia clinic of the Universitäts-Frauenklinik Tübingen in June 2004 because of a PAP IVa cervical smear. A colposcopic biopsy from this
Simple vaginal trachelectomy for early stage cervical cancer: A tertiary cancer center experience
Ginekologia Polska
Objectives: Less radical fertility sparing procedures have been introduced to reduce morbidity and adverse obstetric outcome in cervical cancer. Our objective was to describe oncological and obstetric outcomes of women with early-stage cervical cancer who underwent a simple vaginal trachelectomy (SVT). Material and methods: From 01/2013 to 05/2017, 14 women underwent SVT preceded by laparoscopic pelvic lymph node dissection. Results: Patients' median age was 32 years and all of them were nulliparous. Histology included squamous cell carcinoma and adenocarcinoma in 12 (85.7%) and 2 (14.3%) patients, respectively. Three patients had stage 1A1 with lymphovascular space invasion, 4 1A2 and 7 1B1. After obtaining final histopathology, one patient underwent radical hysterectomy due to positive surgical margin and excluded from analysis. None of the patients had lymph node metastasis. None of the 13 patients developed a recurrence within a median follow-up of 27 (6-56) months. Seven patients have conceived: 4 were term deliveries, 2 were late preterm deliveries and 1 was spontaneous abortion. Conclusions: SVT in well selected early-stage cervical cancer patients seems to be a safe treatment option with excellent oncologic outcome, preserving reproductive function. Literature data will need to be confirmed in large prospective series.