Abstract
BackgroundRadical 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.MethodsWe 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.ResultsAll 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.ConclusionsBoth the obstetrical prognosis and oncological prognosis after vaginal RT have become favorable for pregnant patients after vaginal RT.
Highlights
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
We summarize the clinical profile of pregnancy after vaginal RT in our institute and review the obstetrical management of pregnancy after vaginal RT
Clinical stage 1B2 and higher stages are beyond the indication for RT in our hospital, RT was performed for a patient with stage IIA who strongly desired the preservation of fertility after repeated explanations to her and her family
Summary
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. Radical trachelectomy (RT) with pelvic lymphadenectomy, originally reported by Dargent et al in 1988 [1], has become a new treatment option for young patients in Japan with early invasive uterine cervical cancer who desire preservation of their fertility [2,3,4]. This operative modality is recently performed even during pregnancy [5]. They still usually need long-term obstetrical treatments over the course of the pregnancy
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