Robotic-assisted radical trachelectomy for early-stage cervical cancer: reproductive outcomes

Abstract

<h3>Objectives:</h3> We sought to evaluate pregnancy-related outcomes in women who elected to undergo uterine-artery preserving robotic-assisted radical trachelectomy (RRT) for fertility-sparing treatment of early stage cervical cancer. <h3>Methods:</h3> This is a retrospective, multi-institutional, international study of patients who underwent attempted uterine artery-preserving RRT for primary treatment of FIGO 2009 clinical stage IA1, IA2 and stage IB1 cervical cancer. All consecutive patients undergoing surgery at 5 academic centers in Sweden, the US, England, and South Korea between December 2007 and September 2019 were included. RRT was performed as a fertility-sparing treatment for stage IA2 and IB1 disease as well as for stage IA1 disease with lymphovascular space invasion, multifocal disease, adenosquamous histology, or a cone biopsy with positive margins. Demographic and clinical data were collected via chart review. We used Student´s T-test or Mann Whitney to compare continuous variables and Pearson´s Chi²-test for categorical variables. Variables were entered into a Microsoft Excel database and analyzed using SPSS version 12.0 statistical software (SPSS, Chicago, IL, USA). <h3>Results:</h3> Of 194 patients taken to the OR for attempted RRT, 185 underwent RRT, and 176 had bilateral preservation of the uterine arteries. Mean age was 31 years (range 18 to 51). Histologic classifications included squamous cell (n=111), adenocarcinoma (n=65), and adenosquamous (n=6). A total of 9 patients had aborted RRT for intraoperative finding of a positive node or margin. A total of 8 patients underwent completion hysterectomy based on final pathology. A total of 15 patients received adjuvant treatment. Of the 155 patients who had neither hysterectomy nor adjuvant therapy, 91 (58.7%) attempted pregnancy and 69 (75.8%) achieved pregnancy. Of a total of 100 pregnancies, there were 70 live births (70%), 21 first trimester losses (21%), 5 second trimester losses (5%), and 4 (4%) patients are currently pregnant. Of the live births, 6 (8.6%) were delivered very preterm before 32 weeks gestation and 52 (74.3%) were delivered via planned cesarean section after 36 weeks. Compromise of at least one uterine artery significantly increased the rate of delivery before 36 weeks (17% vs 2%, p=0.02). The median follow-up was 51 months. <h3>Conclusions:</h3> Preservation of the uterine arteries bilaterally may lead to improved obstetric outcomes. This is the largest series reporting outcomes of uterine-artery preserving RRT to date and provides important data for counseling patients considering fertility-sparing treatment of early cervical cancer.