Fertility-conserving treatment of early stage cervical cancer using trachelectomy and laparoscopic lymphadenectomy-a case report and a review of recent literature (original) (raw)
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Fertility sparing surgeries for early stage cervical cancer with special emphasis on enhancement of fertility outcomes&prevention of preterm delivery irrespective of the mode used for trachelectomy :A A Short Communication, 2023
Having reviewed earlier the significance of fertility preservation in cancer survivors in the context of ovarian tumors management with those in particular who receive alkylating agents,like Cyclophosphamide chemotherapy here we further emphasize on collaboration amongst the treating reproductive endocrinologist in addition to Gynaecological oncologists.Here we discuss the reproductive and oncological results following fertility sparing surgery for early stage cervical cancer [ESCC] (specifically stage IA1 -1B1) which was inclusive of cold knife conisation/simple trachelectomy, laparoscopic radical trachelectomy with/ without Robotic assistance as reviewed by Nezhat etal.for the first time ina systematic review with highlighting the role of fertility sparing surgery in early stage cervical cancer with a correlation of the fertility outcomes including clinical pregnancies rates,spontaneous/by assisted reproductive technology(ART),rather than the earlier canonical gold standard therapy for of inclusive of total hysterectomy, radical hysterectomy with/ without lymph node removal radical hysterectomyeven for ESCC.He initially started Laparoscopic strategy&finally cold knife conisation/simple trachelectomy. Further the incidence of preterm birthswasfound to be higher.Here we further updated on the future work by others workers keeping that study as a reference with role of conization , radical trachelectomy by abdominal vaginal trachelectomyor simple conisation.For preterm birth it has been confirmed that the cone dimensions make a big difference with regards to preterm delivery with cervix <10mm at greater risk ,however role of iatrogenic pretermdelivery with obstetricians performing elective LSCS with removal of cerclage.Furthermore certain HPV phenotypes might be associated with greater recurrence rates.Thus multiInstitutonal, Interdisciplinary team work is needed amongst, various specialities toobtain maximum outcomes with most experienced Gynaecological oncologists having high volume of work for most effective trachelectomy with avoidance of spillage,proper margins tumor free left back.However shifting from the gold standard radical hysterectomy to more fertility sparing surgery in early stage cervical cancer needs to be highlighted with referral in expert hands will pave a way towards fertility in young cervical cancer patients. Key Words; early stage cervical Cancer; fertility sparing surgery; future fertility; Obstetric outcomes
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.
Acta Chirurgica Latviensis, 2016
SummaryTraditionally the treatment for invasive cervical carcinoma which has progressed beyond micro invasion has been radical hysterectomy, unfortunately directly affecting fertility. Long term experience of radical surgery for Stage IB carcinoma has shown that it produces excellent results in terms of survival; however there is always a loss of potential for future fertility. Increasingly large numbers of young women (24-35 years) are being diagnosed with cervical cancer (7). Saving uterus where is safely possible is the main challenge to a surgeon as the loss of fertility for women can be devastating.Approximately one-third of infertility is attributed to the female partner, one-third attributed to the male partner and one-third is caused by a combination of problems in both partners.The incidence of a cervical cancer diagnosis in reproductive age women has increased in parallel to the quality in diagnostic in Latvia. However along with a scientifically evident knowledge, new sur...
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.
2020
Introduction: Fertility-sparing strategies are suggested for selected patients with cervical cancer, who wish to preserve their fertility, which includes neoadjuvant chemotherapy, conization, and trachelectomy. Radical trachelectomy is suggested as a safe method with favorable outcomes. However, the controversy about the success rate, fertility rate, and risk of recurrence of radical trachelectomy questions its applicability. Case Presentation: Here, we presented a 39-year-old woman with high-grade invasive cervical cancer, squamous cell carcinoma (SCC) which was successfully managed by laparoscopic lymphadenectomy and radical trachelectomy and leading to normal pregnancy in the following years. Conclusions: This case report suggests that this procedure should be considered in selected patients, especially those who wish to have a child in the future. Besides, it is recommended that obstetricians pay greater attention to post-trachelectomy pregnancies to reduce the complication rates.
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
Cervical cancer still remains one of the major problems in developing countries. The last decade of 20th century has seen a trend towards more conservative surgical approaches in the treatment of early-stage disease in young patients. The trend of delaying childbearing, nowadays, increases preservation of fertility, and reproductive function is a major concern when counseling these young women with regard to the effects of treatment for cervical cancer. Radical trachelectomy, either with abdominal or vaginal surgical approach, showed promise as treatment option in young patients with early cervical cancer. The basic principle of such a surgical approach is an operation aiming at preserving the uterine body and removing the cervix, parametrium, with bilateral pelvic lymphadenectomy, and creating a utero-vaginal anastomosis, either laparoscopically or by laparotomy. Both surgical approaches are evaluated after a search of the relevant literature in Pub Med or Medline.
Laparoscopic fertility sparing management of cervical cancer
International journal of fertility & sterility, 2014
Fertility can be preserved after conservative cervical surgery. We report on a 29-year-old woman who was obese, para 0, and diagnosed with cervical insufficiency at the first trimester of current pregnancy due to a previous trachelectomy. She underwent laparoscopic transabdominal cervical cerclage (LTCC) for cervical cancer. The surgery was successful and she was discharged two days later. The patient underwent a caesarean section at 38 weeks of gestation. Laparoscopic surgery is a minimally invasive approach associated with less pain and faster recovery, feasible even in obese women.
Case Reports in Surgery, 2013
Fertility preservation in early-stage cervical cancer is a hot topic in gynecologic oncology. Although radical vaginal trachelectomy (RVT) is suggested as a fertility preserving approach, there are some serious concerns like cervical stenosis, second trimester loss, preterm delivery in survivors, and lack of residual tumor in the majority of the surgical specimens. Therefore, less radical surgical operations have been proposed in early-stage cervical carcinomas. On the other hand, single-incision laparoscopic surgery (SILS) is an evolving endoscopic approach for minimal access surgery. In this report, we present a case with early-stage cervical cancer who wishes to preserve fertility. We successfully performed single-port pelvic lymphadenectomy and large conization to preserve fertility potential of the patient. We think that combination of less radical approach like conization and single-port pelvic lymphadenectomy might be less minimally invasive and is still an effective surgical...