Abdominal Radical Trachelectomy Research Articles

Surgical, oncologic, and obstetric outcomes of radical trachelectomy in early-stage cervical cancer: results from a retrospective cohort study at Brazil National Cancer Institute.

to analyze oncological, obstetrical, and surgical results of young early-stage cervical cancer patients who underwent radical trachelectomy (RT) surgery and wished to maintain their fertility. a retrospective cohort study was carried out concerning cases attended at the Brazilian National Cancer Institute Gynecology Oncology Service. Patients who underwent RT between January 2005 and January 2021 were included. A total of 32 patients with median age of 32 years old, 62.5% of whom were nulliparous, were assessed. Concerning cancer type, 65.6% squamous cell carcinoma (SCC) cases, 31.2% adenocarcinoma cases and 3.1% adenosquamous carcinoma cases were verified. Stage IA2 was evidenced in 12.5% of the patients and stage IB < 4cm in 87.5%. Regarding surgical approaches, 68.25% of the patients underwent vaginal RT (VRT), 18.75%, abdominal RT (ART), 9.3%, the robotic radical trachelectomy (RORT) and 3.1%, video laparoscopy radical trachelectomy (VLRT). The median number of removed lymph nodes was 14, with only two detected as positive. Two cases of positive surgical margins were noted. A total of 3.1% intraoperative and 31.25% postoperative complications were observed, with cervical stenosis being the most common. The recurrence rate of the study was 3.1%, with a median follow-up time of 87 months, where 3.1% deaths occurred. The pregnancy rate of the study was 17.85% (5/28), with 54.5% evolving to live births and 45.5% evolving to abortion. Radical trachelectomy is a feasible procedure presenting good oncological results and acceptable pregnancy rates.

Announcement of First Successfully Pregnancy Following Abdominal Radical Trachelectomy in Viet Nam

Objectives: Abdominal radical trachelectomy (ART) is an alternative treatment for preserving fertility in selected patients with early - stage cervical cancer. This report to announce one case of successful conceive and gave birth following the abdominal radical trachelectomy. Materials and Methods: We have performed 12 cases of radical trachelectomy with pelvic lymphadenectomy in The Oncology Hospital of Ho Chi Minh city between January 2018 and December 2022. One of them has successful live birth after procedure about six months.Results: The characteristics of the 12 adult patients, who underwent radical trachelectomy, included stage IB1 disease in all cases, a mean age of 31 years (range, 29–41), and a median estimated blood loss of 100 ml (range, 70–150). No one needed adjuvant treatments after surgery, and all cases resumed normal menstruation postoperatively. There were no intraoperative complications. Transurethral Foley catheters were removed in all cases at postoperative days 02 – 04. Cervical stenosis was observed in one case. One case had successfully conceived and gave births following the abdominal radical trachelectomy. All patients remain disease-free after a median 3 - year follow-up. Conclusions: ART with pelvic lymphadenectomy is a feasible operation for selected women with early-stage cervical cancer cases who desire to preserve reproductive function. Menstruation and reproductive function might be preserved after bilateral uterine vessel ligation.

Neoadjuvant chemotherapy followed by radical trachelectomy versus upfront abdominal radical trachelectomy for patients with FIGO 2018 stage IB2 cervical cancer

ObjectiveTo explore the optimal fertility-sparing treatment for stage IB2 cervical cancer. We compared the outcomes of neoadjuvant chemotherapy (NACT) followed by radical trachelectomy (RT) with those of upfront abdominal RT (ART). MethodsThis is a retrospective study with prospectively collected data between August 2015 and July 2019. Patients with IB2 cervical cancer who desired fertility preservation underwent NACT followed by RT, or upfront ART, per their choice. ResultsThis study included 51 patients, of which, 16 patients underwent NACT followed by RT and 35 patients chose upfront ART. Fertility was preserved in 12 (75.0%) and 27 (77.1%) patients from the NACT and upfront ART groups, respectively. Incidence rates of intraoperative (0% versus 3.7%) and postoperative complications (25.0% versus 48.1%) of the NACT group were lower compared to the upfront ART group (P=NS). Eleven (91.7%) patients in NACT group and 17 (63.0%) patients in upfront ART groups received adjuvant chemotherapy after surgery. The median follow-up, and 5-year recurrence-free survival rates of the NACT-RT and upfront ART groups were 56 and 61 months, and 83.3% and 96.3%, respectively (P=NS). The recurrence rate was higher in patients with tumor reduction <50% after NACT than that in patients with tumor reduction >50% (66.7% versus 0%, P < 0.05). Tumor reduction <50% was the only independent predictor of recurrence in patients who underwent NACT before RT. ConclusionsNACT followed by RT could be a feasible fertility-sparing option for selected patients with 1B2 cervical cancer. The NACT group had a relatively higher recurrence rate and fewer complications compared to the upfront ART group, albeit without statistical significance. Patients with tumor regression >50% after NACT could be ideal candidates for RT after NACT.

Fertility-sparing surgery in early-stage cervical cancer: laparoscopic versus abdominal radical trachelectomy

BackgroundRadical trachelectomy is an acceptable alternative to radical hysterectomy for patients with early-stage cervical cancer who wish to preserve reproductive function. This study is designed to compare the laparoscopic versus abdominal radical trachelectomy and provide oncological and obstetric outcome data on patients who have undergone fertility-sparing surgery.MethodsWe retrospectively analyzed all early-stage cervical cancer patients who underwent abdominal radical trachelectomy (ART) or laparoscopic radical trachelectomy (LRT) between January 2005 and June 2017 in West China Second University Hospital, Sichuan University. Patients' clinical details and follow-up were obtained from hospital records.ResultsA total of 33 patients (5 with IA1, 2 with IA2, and 26 with 1B1) were included, including 18 patients treated with ART and 15 patients treated with LRT. The median age at initial diagnosis was 30.00 ± 4.30 years (range 22–39). The mean follow-up time was 74.67 months. Among the 33 patients, 2 patients (6.06%, 1 abdominal/1 laparoscopic) developed recurrence, and there are no evidence of disease for the remaining 31 patients till now. The overall survival rate 96.99% (32/33). The LRT group had a shorter hospital stay (P = 0.01) and less blood loss (P < 0.01) than the ART group. There is no significant difference in the length of operative time (P = 0.48) between the two surgical routes. Overall, 15/33 patients (45.45%) have tried to conceive. 6 (40.00%) patients were pregnant and 6 (40.00%) patients were infertility. The ART group had a higher clinical pregnancy rate (P = 0.03) than the LRT group.ConclusionsThere is no statistically significant difference in oncological outcome between the two surgical approaches. The clinical pregnancy rate in the ART group was significant higher than that in the LRT group. However, LRT resulted in less blood loss and decreased length of hospital stay.

Fetal biometric and Doppler measurements following abdominal radical trachelectomy in the second trimester of the pregnancy

BackgroundOur previous study demonstrated the safety and effectiveness of abdominal radical trachelectomy during pregnancy but did not focus on the fetus. This study aimed to clarify the influence of abdominal radical trachelectomy performed during pregnancy on the fetus.MethodsEight cervical cancer patients who underwent abdominal radical trachelectomy at our hospital between February 2013 and August 2020 were enrolled in this study. To assess the peri- and postoperative influence on the fetus, we performed fetal heart monitoring at 30-min intervals during abdominal radical trachelectomy and calculated the estimated fetal body weight and resistance indexes of the middle cerebral artery and umbilical artery from postsurgery until delivery.ResultsFour out of eight patients had preterm birth due to chorioamnionitis in one case and consideration of the recurrent risk of cervical cancer in three cases. Fetal heart monitoring during abdominal radical trachelectomy revealed deceleration just once in one case but no abnormal findings in the other cases. In all cases, the fetal growth after abdominal radical trachelectomy was normal until delivery. No abnormal Doppler findings were detected in the middle cerebral artery or umbilical artery.ConclusionOur findings clarified that abdominal radical trachelectomy performed for the treatment of early-stage cervical cancer during pregnancy has no obvious influence on fetal growth. Next, it is necessary to evaluate the growth and development of children delivered from mothers who have undergone abdominal radical trachelectomy during pregnancy.

294. Abdominal radical trachelectomy as a fertility-sparing treatment for early-stage cervical cancer; a single institution experience

Introduction and aims of the study: The recommended surgical treatment for FIGO stage IA2–IB1 cervical cancer is radical hysterectomy with bilateral pelvic lymphadenectomy. Unfortunately, this procedure leads to loss of fertility. Abdominal Radical Trachelectomy (ART) is a procedure that preserves the uterus without increasing the risk of recurrence while retaining childbearing potential. We describe the surgical, oncologic, and fertility outcomes of patients treated with ART. Methods: We conducted a retrospective analysis of patients undergoing fertility-sparing ART with pelvic lymphadenectomy for early-stage cervical cancer at our institution from 2002 to 2016. Results: A total of 80 patients who underwent ART with pelvic lymphadenectomy were followed for 2–106 months. Thirty-two patients had undergone conization before surgery. The characteristics of the patients included tumor diameter of 8–32 mm (stage IA2 = 10, stage IB1 [b3.2 cm] = 70), average age of 29.5 years (range, 26–43 years), mean operative time of 185 min (range, 142–245 min), and average blood loss of 350 mL (range, 150– 750 mL). Uterine arteries were identified at their origin from the internal iliac artery and gently preserved in 76 cases. There were two recurrences in the paraaortic area treated with chemoradiation (n = 1) and radical hysterectomy (n = 1). Three patients developed high-grade squamous intraepithelial lesions and were successfully treated by loop excision. Forty-five women attempted to conceive, and 34 successful pregnancies were recorded (75%). All of the pregnancies resulted in live births, with a preterm delivery rate of 17.6% (6/34). Conclusions: Our study is one of the largest series of ART to date. Our results show that radical abdominal trachelectomy is feasible and can be performed safely in well-selected patients with cervical cancer who wish to preserve their fertility.

Radical Vaginal Trachelectomy.

Recently, radical vaginal hysterectomy (RVH) has developed into laparoscopically assisted radical vaginal hysterectomy (LARVH), which is associated with the laparoscopical procedure, and it is applied as radical vaginal trachelectomy and semi-radical vaginal hysterectomy. LARVH is indicated for patients with stage IB1 and IIA1 cervical carcinoma, especially those with a tumor size of less than 2 cm, because the cardinal ligaments cannot be resected widely. Although RVH that is associated with laparoscopic pelvic lymphadenectomy is the most used surgical procedure, radical trachelectomy may be performed either abdominally or vaginally (laparoscopic or robotic). One report found that the pregnancy rate was higher in patients who underwent minimally invasive or radical vaginal trachelectomy than in those who underwent radical abdominal trachelectomy.

Clinical Study of Sentinel Lymph Node Detection Using Photodynamic Eye for Abdominal Radical Trachelectomy.

This study aimed to assess the accuracy of predicting pelvic lymph node status using sentinel lymph node (SLN) biopsy with indocyanine green (ICG) and to examine the outcomes of SLN biopsy-guided abdominal radical trachelectomy (ART). Patients with stage IA2–IB2 cervical cancer from January 2009 to January 2021 were included. ICG was injected before ART and SLNs were identified, excised, and assessed intraoperatively using fast-frozen sections. Systemic pelvic lymphadenectomy was subsequently performed. The SLN detection rate, sensitivity, and false-negative rate were determined. Thirty patients desiring fertility preservation were enrolled, of whom 26 successfully completed ART and four underwent radical hysterectomies because of metastatic primary SLNs. Bilateral SLNs were identified in all patients. The sensitivity, false-negative rate, and negative predictive value were 100%, 7.7%, and 92.3%, respectively. Three (12%) patients were lost to follow-up: two relapsed and one died of tumor progression. Of the nine patients who tried to conceive after surgery, four achieved pregnancy and three delivered healthy live infants. In women with early-stage cervical cancer who desired to conserve fertility, SLN mapping with ICG had a very high detection rate, sensitivity, and low false-negative rate. SLN biopsy-guided ART is a feasible and accurate method for assessing pelvic node status.

Abdominal Radical Trachelectomy.

Abdominal radical trachelectomy is a fertility-sparing surgery for early invasive cervical cancer. The surgical steps involved in abdominal radical trachelectomy are similar to those for radical hysterectomy prior to removal of the uterus. The difference is that in trachelectomy, the uterine corpus and infundibulopelvic ligament are conserved and the cervical remnant is connected to the vaginal wall. Surgeons should pay close attention to avoiding postsurgical complications such as infection and ileus, which might interfere with subsequent fertility treatments.

Cervical Cancer and Fertility-Sparing Treatment.

Radical hysterectomy with pelvic node dissection is the standard treatment for early-stage cervical cancer. However, the latter can be diagnosed at a young age when patients have not yet achieved their pregnancy plans. Dargent first described the vaginal radical trachelectomy for patients with tumors <2 cm. It has since been described a population of low risk of recurrence: patients with tumors <2 cm, without deep stromal infiltration, without lymphovascular invasion (LVSI), and with negative lymph nodes. These patients can benefit from a less radical surgery such as conization or simple trachelectomy with the evaluation of the pelvic node status. Tumors larger than 2 cm have a higher risk of recurrence and their treatment is a challenge. There are currently two options for these patients: abdominal radical trachelectomy or neoadjuvant chemotherapy (NACT), followed by fertility-sparing surgery. All patients who wish to preserve their fertility must be referred to expert centers.

A Decade of Experience with Radical Abdominal Trachelectomy after Supracervical Hysterectomy

A Decade of Experience with Radical Abdominal Trachelectomy after Supracervical Hysterectomy

Abdominal radical trachelectomy as fertility-sparing management for early stages of cervical cancer: Our experience in 18 cases.

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.

Expectant management for early pregnancy miscarriage after radical trachelectomy: A single hospital‐based study

Women who have undergone radical trachelectomy as a fertility-sparing treatment for early-stage cervical cancer may be at higher risk for retained tissues after early-term miscarriage due to cervical cerclage or cervical necrosis. Dilatation and curettage or aspiration may present additional risks in these women. The aim of this study was to assess the efficacy of expectant management for early pregnancy miscarriage after radical trachelectomy. Keio University Hospital records were reviewed for women who conceived after abdominal radical trachelectomy and received perinatal care between 1 April 2012 and 31 March 2020. A total of 62 women (76 pregnancies) were identified, and 13 of these women experienced miscarriage before 12 gestational weeks. The management and outcome of these cases were reviewed in detail. The median maternal age at miscarriage was 39years (range 31-42years) and the median duration from abdominal radical trachelectomy to conception was 2.60years (range 0.49-7.30years). Cervical necrosis before conception occurred in one case (8%). One patient requested treatment with aspiration and the remaining 12 cases were managed with observation for a median of 23days (range 7-50days). There were no cases of endometritis or cases requiring dilatation and curettage for residue tissue. Further, no cases developed laceration of the residual cervix and no loss of cerclage sutures after discharge was noted. Expectant management seems to be safe and appropriate for first trimester miscarriage after abdominal radical trachelectomy.

Experience of performing radical trachelectomy with uterine transposition in organ-preserving treatment of stage IB-II invasive cervical cancer

The development and implementation of organ-preserving treatment modalities is the priority trend in the current cancer treatment of patients of the reproductive age. Methods of expanding indications for organ-preserving treatment in cancer patients are becoming relevant. We present our experience in performing radical trachelectomy with uterine transposition in patients with stage IB-II cervical cancer. Our surgical technique allows the preservation of the uterus and adnexa in patients with invasive cervical cancer, who need to receive combined modality treatment including extended surgery followed by chemotherapy or radiation therapy to the pelvis. Transposition of the uterus and adnexa after radical abdominal or laparoscopic trachelectomy allows the movement of the uterus and ovaries out of the radiation field. After completion of radiation therapy, the uterus with adnexa is repositioned into the pelvis and uterine-vaginal anastomosis is formed using an implant made of titanium nickelide. Independent pregnancy and the use of assisted reproductive technologies are permitted after passing the time when distant metastases are most likely to develop.

The Double Life-Saving Approach of Abdominal Radical Trachelectomy during Pregnancy for Early-Stage Cervical Cancer-An Overview of the Literature and Our Institutional Experience.

(1) Background: Cervical cancer is the most common type of cancer encountered during pregnancy, with a frequency of 0.8–1.5 cases per 10,000 births. It is a dire condition endangering patients’ lives and pregnancy outcomes, and jeopardizing their fertility. However, there is a lack of current evidence and consensus regarding a standard surgical technique for pregnant patients who suffer from this condition during pregnancy. The study aims to comprehensively update all published data, evaluating the obstetrical and oncological results of pregnant patients who underwent abdominal radical trachelectomy during early stages of cervical cancer. (2) Methods: A literature search on the Medline, PubMed, and Google Scholar databases was performed, including all articles in question up to July 2020. This study presents an overview of the literature and our institutional experience. (3) Results: A total of 25 cases of abdominal radical trachelectomy were performed during pregnancy for early cervical cancer, including the five cases managed by the authors. Of these, 81% (19 patients) gave birth to live newborns through elective C-section, and 19% (6 patients) experienced miscarriage shortly after the procedure. None of the 25 patients (100%) reported disease recurrence. (4) Conclusions: The results of the current study were satisfactory. However, abdominal radical trachelectomy does not represent the current standard of care for cervical cancer during pregnancy, but it could play an important role if more evidence on its effectiveness will be provided.

Important Factors of Successful Pregnancies and Deliveries After Abdominal Radical Trachelectomy for Early-stage Cervical Cancer; Single-institution Experience

We assessed pregnancies and deliveries after abdominal radical trachelectomy (ART) based on reproductive outcomes. We retrospectively analyzed patients undergoing ART in our hospital from 2011 to 2020. Twenty-one patients (median age, 35 [range 27-40] years) with histologically diagnosed cervical cancer (squamous cell carcinoma [n=16], adenocarcinoma [n=4] and adenosquamous carcinoma [n=1]) underwent ART. Clinical stages (FIGO 2018) were IA1 (n=2), IA2 (n=5) and IB1 (n=14). Median follow-up period was 49 (1-108) months with no post-ART recurrence. Among 10 patients with post-ART planned pregnancies, 6 patients had pregnancies. Although all patients in the pregnancy group had pregnancies at the first fertility treatment, none of patients in the non-pregnancy group had pregnancies after several fertility treatment. Age, period after ART and the rate of bilateral uterine arteries preservation showed no significant difference between the pregnancy and non-pregnancy groups. Residual cervical length was about 10 mm in the pre-term delivery group and over 20 mm in the full-term delivery group. Age, fertility treatment and score of normal bacteria flora of the vagina showed no significant difference between pre-term delivery group and full-term delivery group. Bilateral uterine arteries preservation in the ART procedures were not associated with pregnancies after ART. Residual cervical length was associated with gestational age at delivery.

Reproductive outcomes after radical abdominal trachelectomy for cervical cancer

Reproductive outcomes after radical abdominal trachelectomy for cervical cancer

A rare case of abdominal radical trachelectomy following C-section for early-stage cervical cancer

A rare case of abdominal radical trachelectomy following C-section for early-stage cervical cancer

Minimally invasive versus open radical trachelectomy for early-stage cervical cancer: protocol for a multicenter randomized controlled trial in China

BackgroundThere are limited data comparing the oncologic and fertility outcomes of patients with early-stage cervical cancer (CC) treated by minimally invasive radical trachelectomy (MIRT) or abdominal radical trachelectomy (ART). The purpose of this multicenter study is to compare the oncologic and fertility outcomes of patients treated by MIRT or ART in a randomized controlled manner in China.MethodsThis is a noninferiority, randomized controlled trial performed at 28 Chinese centers; the study is designed to compare the oncologic and fertility outcomes of patients treated by MIRT (robot-assisted or laparoscopic RT) or ART. Patients will be recruited if they have been diagnosed with stage IA1 (with lymphovascular space invasion), IA2, or IB1 CC (with a maximum tumor diameter ≤ 2 cm) in the FIGO 2009 staging system and histological subtypes of squamous carcinoma, adenocarcinoma, or adenosquamous carcinoma and if they are also aged 18 to 40 years. These candidates will be randomly assigned to undergo MIRT or ART. The primary endpoint will be disease-free survival. Secondary endpoints will consist of overall and disease-free survival rates, fertility outcomes, and quality of life. A total of 414 patients are needed to accomplish the study goal, with 90.1% power at a 0.050 significance level to detect an equivalence hazard ratio of 0.75 in the ART group, considering 20% loss to follow-up.DiscussionThe results of the trial should provide robust evidence to surgeons regarding options for the surgical approach in patients with early-stage CC who have a strong willingness to preserve fertility.Trial registrationClinicalTrials.gov NCT03739944. Registered on November 14, 2018

Oncological and Reproductive Outcomes of Abdominal Radical Trachelectomy.

Background/Aim: There is an increasing demand for preserving the fertility of young women impacted with early-stage cervical cancer. The aim of this study is to evaluate the oncological and reproductive outcomes of abdominal radical trachelectomy (ART). Patients and Methods: We retrospectively reviewed patients with FIGO stageIA2-IB1 cervical cancer who underwent ART from 2007 to 2018. We also compared the oncological prognosis between the patients who underwent ART and radical hysterectomy (RH). Results: A total of 42 patients underwent ART. During median follow-up 62.5 months, there were 4 (9.5%) recurrences and 1 (2.4%) death. As for tumors ≤2 cm, the 5-year recurrence-free survival (RFS) rate and overall survival (OS) rate for patients who underwent ART was similar to those who underwent RH (89.8% vs. 92.7%, p=0.42 and 97.3% vs. 95.0%, p=0.44, respectively). Nineteen patients attempted to conceive and seven of them were successful. There was one case of a first-trimester miscarriage, two cases of preterm delivery, three cases of full-term delivery and one ongoing pregnancy. Conclusion: ART could be a feasible alternative to RH for patients with tumors ≤2 cm with comparable oncological outcome.