Abdominal Radical Trachelectomy Research Articles

Radical Trachelectomy for the Treatment of Early-Stage Cervical Cancer: A Systematic Review.

To assess surgical, oncologic, and pregnancy outcomes in patients undergoing radical vaginal, abdominal, or laparoscopic trachelectomy for the treatment of early-stage cervical cancer, using a methodic review of published literature. PubMed, EMBASE, and Cochrane Library sources, including ClinicalTrials.gov, were searched from 1990-2019 with terms "cervical cancer" and "(vaginal, abdominal, open, minimally invasive, or laparoscopic) radical trachelectomy." Grey literature and unpublished data were omitted. After removal of duplicates from a combined EndNote library of results, 490 articles were reviewed using Covidence software. Two reviewers screened titles and abstracts, and then screened full texts. Selection criteria included articles that reported radical trachelectomy with lymph node assessment as primary therapy for cervical carcinoma, with stated follow-up intervals and recurrences. Variables of interest were manually extracted into an electronic database. A total 47 articles that reported on 2,566 women met inclusion criteria. Most tumors were of squamous histology (68.5%), stage IB1 (74.8%), 2 cm or less (69.2%), and without lymphovascular invasion (68.8%). Of planned trachelectomies, 9% were converted intraoperatively to hysterectomy. Separated by route of trachelectomy, 58.1%, 37.2%, and 4.7% were performed using radical vaginal, abdominal, and laparoscopic approaches, respectively. With median follow-up of 48 months (range 2-202 months) across studies, median recurrence rate was 3.3% (range 0-25%); median time to recurrence was 26 months (range 8-44 months). Median 5-year recurrence-free and overall survival were 94.6% (range 88-97.3%) and 97.4% (range 95-99%), respectively. The posttrachelectomy pregnancy rate was 23.9%, with a live-birth rate of 75.1%. Radical trachelectomy for fertility-preserving treatment of cervical cancer is widely reported in the literature, though publications are mainly limited to case reports and case series. Reported follow-up periods infrequently meet standard oncologic parameters but show encouraging recurrence-free and overall survival rates and pregnancy outcomes. Higher-level evidence needed for meta-analysis is lacking. PROSPERO, CRD42019132443.

An Australian, single-centre study of surgical management outcomes for early-stage cervical cancer.

The Laparoscopic Approach to Cervical Cancer (LACC) trial is the first phase III randomised, multicentred trial to compare oncologic outcomes associated with open radical hysterectomy vs minimally invasive surgery (MIS) for treatment of early cervical cancer. To evaluate our surgical experience in patients with early cervical cancer. The Lifehouse Gynaecologic Oncology database was queried based upon the eligibility criteria of the LACC study and included all FIGO 2009 stage (1A1 with lymph vascular space invasion, 1A2, 1B1) cervical cancer women from 2008-2018. Patients were also included in our study if they had abdominal radical trachelectomy (ART), laparoscopic radical hysterectomy (TLRH) and robotic radical trachelectomy (RRT). Forty-six women were identified with four exclusions. Thirty-seven women had stage 1B1 disease, 24 had a squamous cell carcinoma, 15 had an adenocarcinoma and three had an adenosquamous carcinoma of the cervix. Of the 42 eligible patients, 32 underwent an open abdominal approach (26 total abdominal radical hysterectomy (TARH), six ART) and ten a MIS approach (nine TLRH and one RRT) with a mean follow-up of 4.8years. All 42 women had a pelvic lymph node dissection, eight women had nodal metastases and 16 patients received adjuvant chemoradiation. Two of the nine women in the laparoscopic radical hysterectomy group had a recurrence. Both had adenocarcinoma, stage 1B1 disease. There were no recurrences in the TARH group or radical trachelectomy groups. Our data, albeit limited in number, have reflected the results of the LACC trial that MIS was associated with a lower disease-free survival than open radical hysterectomy.

The safety and effectiveness of preserving the ascending uterine artery in a modified fertility-sparing abdominal radical trachelectomy

ObjectiveTo evaluate the outcome of preserving the ascending uterine artery in a modified fertility-sparing abdominal radical trachelectomy and understand whether preserving uterine arteries during abdominal radical trachelectomy is helpful for patients. MethodsFrom September 2005 to September 2019, 31 early uterine cervical cancer patients who underwent modified fertility-sparing abdominal radical trachelectomy were enrolled in this study, and were followed up in our cancer center. Computed tomography (CT) of the abdomen and pelvis was advised as the initial investigation to evaluate the ascending uterine artery in 11 patients. The major outcomes were recurrence, mortality, CT results and obstetric outcomes. ResultsDuring the median follow-up of 56 months, two recurrences were recorded. Among 11 patients who underwent CT, none of them showed uterine arteries occlusion. Fifteen patients attempted to conceive, and 5 pregnancies were achieved in 5 patients. Hence, the pregnancy rate among patients who attempted to conceive was 33.3 %. There was only one artificial first-trimester abortion. Three pregnancies resulted in live births, and two of them got full-term births. ConclusionsThe modified fertility-sparing abdominal radical trachelectomy in preserving uterine arteries is effective, and it is recommended that surgeon should retain the uterine artery as much as possible during operation.

The Value of Magnetic Resonance in Assessment of Size, Invasion, Metastasis and Cervical Cancer Stage Classification

This study investigates the value of magnetic resonance (MR) in assessing size, invasion, lymph node metastasis and cervical cancer stage classification in 117 patients who underwent surgery for whole hysterectomy and pelvic lymph node dredge in Vietnam National Cancer Hospital from July 2016 to August 2018. The study results show that tumor size accuracy (Acc) was 93.2%; vaginal invasion Sp was 98.2%; Acc, 96.6%, NPV, 98.2%; parametrial invasion Sp, 98.2%; Acc, 98.3%, NPV, 100%; pelvic wall invasion Acc , 98.3%; Sp was 115/116, 99.1%; NPV, 99.1%; metastatic lymph node Sp, 98.0%; Acc, 88.9%; NPV, 89.8%. The Acc of the value of MR in cervical cancer stage diagnosis from stage IB was 96.1%; and the overall Acc was 82.9%. The study results also show that the use of MRI in combination with clinical examination in size, invasion, metastasis and cervical cancer stage classification is necessary to improve the accuracy of the diagnosis. 
 Keywords
 Cervical cancer, MRI of cervix.
 References
 [1] Globocan Cervical Cancer, Estimated Incidence, Mortality and Prevalence Worldwide in 2012. http://globocan.iarc.fr/old/FactSheets/ cancers/cervix - new.asp (accessed 30.06.2017). [2] Sala E, Wakely S, Senior E et al. MRI of malignant neoplasms of the uterine corpus and cervix. AJR Am J Roentgenol 188(6) (2007) 1577. [3] Hricak H, Lacey CG, Sandles LG et al. Invasive cervical carcinoma: comparison of MR imaging and surgical findings. Radiology 166(3) (1988) 623.[4] Ngo Thi Tinh, Research invasive level of cervical cancer on stage IB-IIA by clinical, magnetic resonance image and treatment results at K Hospital from 2007-2009. Doctor of Medicine thesis, Hanoi Medical University, 2011 (in Vietnamese).[5] Doan Van Ngoc. Research image characteristics and values of 1.5 tesla magnetic resonance in stage classification and follow treatment of cervical cancer. Doctor of Medicine thesis, Hanoi Medical University, 201 (in Vietnamese).[6] Susan JF, Ahmed MA, Masako YK et al. The Revised FIGO Staging System for Uterine Malignancies: Implications for MR Imaging. RadioGraphics 32(6) (2012). [7] Corrigendum to: Revised FIGO staging for carcinoma of the cervix uteri; Int J Gynecol Obstet 145 (2019) 129.[8] Hoang Duc Kiet. Magnetic resonance image of abdomen and pelvis. Medical Publishing House, (2016), pp.31-44, 329-334 (in Vietnamese).[9] Bourgioti C, Koutoulidis V, Chatoupis K et al. MRI findings before and after abdominal radical trachelectomy (ART) for cervical cancer: a prospective study and review of the literature. Clin Radiol. 69 (2014) 678.[10] Charis B, Konstantinos C, Lia AM, Current imaging strategies for the evaluation of uterine cervical cancer, World J Radiol, 28; 8(4) (2016) 342.
 

Simple conization and pelvic lymphadenectomy in early-stage cervical cancer: A retrospective analysis and review of the literature

ObjectivesTo evaluate the feasibility of cervical conization and laparoscopic pelvic lymphadenectomy as a fertility-sparing surgery to treat early-stage cervical cancer. MethodsWe conducted a retrospective analysis from a prospectively maintained database of patients with stage IA1–IB1 grossly invisible cervical cancers undergoing conization plus laparoscopic lymphadenectomy between January 2014 and July 2019. ResultsForty patients were identified. Five patients (12.5%) had stage IA1 with lymphovascular space invasion, 21 (52.5%) had stage IA2, and 14 (35.0%) had stage IB1. All of the patients had tumors <2 cm. Histology included 35 (87.5%) squamous-cell carcinomas, three (7.5%) adenocarcinomas, and two (5.0%) adenosquamous carcinomas. Median duration of the procedure was 105 min (range, 31–219), and the median estimated blood loss was 50 ml (range, 30–200). One patient received abdominal radical trachelectomy due to the presence of positive margin after conization. Three patients developed postoperative cervical stenosis. After a median follow-up of 35 months (range, 8–74), only one patient (2.5%) developed a recurrence in the remaining cervix, and no patients died. Four of 17 patients attempting to conceive had a spontaneous pregnancy: three delivered at term and one was currently pregnant. ConclusionCervical conization and pelvic lymphadenectomy seems to be an acceptable treatment for well-selected patients with low-risk, early-stage cervical cancer who wish to preserve fertility. It offers excellent oncologic outcomes, low perioperative morbidities, and good reproductive results. Further large prospective studies are warranted to prove the effectiveness of this surgery.

Reproductive and obstetric outcomes after abdominal radical trachelectomy (ART) for patients with early-stage cervical cancers in Fudan, China

ObjectiveTo report the reproductive and obstetric outcomes of patients undergoing abdominal radical trachelectomy (ART) for the treatment of early-stage cervical cancers in Fudan, China. MethodsWe retrospectively reviewed a prospectively collected database of 360 patients with stage IA1-IB1 cervical cancers who underwent ART between 2004 and 2018. ResultsOverall, 211 women (58.6%) did not plan to get pregnant immediately after ART, and 89.6% of them were due to childbearing before surgery or unmarried. Among 149 women who attempted to conceive, 26 (17.4%) of them achieved 30 pregnancies. Eighty-six patients (57.7%) had infertility problems, 44 attempted to conceive with assisted reproductive technologies, and 12 (27.3%) succeeded. Post-operative cervical stenosis (26, 27.4%) and fallopian tube obstruction (22, 23.2%) were the most common reasons for infertility after surgery. Among the patients who conceived, there were 3 first-trimester miscarriages, 6 second-trimester miscarriages, and 2 elective terminations. A total of 19 pregnancies reached the third trimester, and 84.2% of them ended after 36 weeks. Twelve of 20 cases in patients with cerclage placed had full-term birth, while 3 of 5 patients without cerclage placed suffered from second-trimester miscarriage or preterm birth. ConclusionsImmediately after ART, many patients were reluctant to conceive, while others suffered from cervical stenosis or fallopian tube obstruction, which had led to low pregnancy rate. Pregnant patients might experience miscarriage or preterm labor which could be prevented by cervical cerclage. Assisted reproductive technology should be encouraged to improve obstetric outcomes.

Reconstructed uterine length is critical for the prevention of cervical stenosis following abdominal trachelectomy in cervical cancer patients.

Although the procedure of abdominal trachelectomy has been remarkably improved, preventing subsequent cervical stenosis remains challenging. In this study, we analyzed the clinicopathological risk factors for cervical stenosis to explore the appropriate surgical procedures for the prevention of cervical stenosis following trachelectomy. Thirty-two patients who underwent abdominal extended and radical trachelectomy were assessed retrospectively (median follow-up period = 33 months). To evaluate the risk factors, the clinicopathological factors were analyzed by univariate and multivariate analyses. The reconstructed uterine length (UtL), that is, the length between the vaginal end of the neo-cervix and the uterine fundus, was measured by transvaginal ultrasound after surgery. The cut-off value for the UtL was assessed by a receiver operating characteristic (ROC) curve analysis. Cervical stenosis of any grade was observed in 12 patients (grade 1 = 9, grade 3b = 3). Among the various clinicopathological factors, the UtL and cervical length (CL) were significantly related to cervical stenosis following trachelectomy. The multivariate analysis revealed that the UtL, but not CL, is an independent risk factor for stenosis. The ROC curve analysis revealed that stenosis was significantly more likely to occur in patients with a UtL shorter than 53 mm (area under the ROC curve = 0.902). UtL in the patients who became pregnant was longer than that in the patients who did not. No evidence of recurrent cancer was observed during the follow-up period. Our proposed method may provide a functional reconstructed uterus with preserving fertility by remaining UtL more than 53 mm.

Fertility-sparing surgery of cervical cancer >2 cm (International Federation of Gynecology and Obstetrics 2009 stage IB1–IIA) after neoadjuvant chemotherapy

ObjectiveTo assess the feasibility, safety, oncological, and obstetric outcomes in patients with cervical tumors >2 cm treated with neoadjuvant chemotherapy in preparation for abdominal radical trachelectomy.MethodsA retrospective analysis of patients...

Oncological results and recurrent risk factors following abdominal radical trachelectomy (ART): An updated series of 333 patients

Objective: To update the oncological results and identify recurrent risk factors in young patients with early-stage cervical cancers following abdominal radical trachelectomy (ART) at our institution.

Obstetric outcomes after abdominal radical trachelectomy (ART) for early-stage cervical cancers: A retrospective analysis of 341 cases in China

Objective: We sought to report the obstetric outcomes of young patients undergoing abdominal radical trachelectomy (ART) for the treatment of early-stage cervical cancers in China.

Our ideas and devices to establish stable and precise procedures in robotic radical trachelectomy for cervical cancer patients

Objective: To preserve fertility of cervical cancer patients, we started abdominal radical trachelectomy (ART) in 2005 and accomplished successful surgical outcome with only 1 recurrence in almost 200 cases slightly including abdominal modified-radical or simple trachelectomy. With almost 40% of patients who attempted to conceive after their abdominal trachelectomies, almost 40% of them became pregnant. However, many cases needed artificial insemination by husband or artificial reproductive technology to be pregnant. Therefore, we started to shift ART to robotic RT (RRT), which may bring not only minimal invasiveness but also increased spontaneous pregnancy rate due to reducing postoperative adhesion.

Rubbing salt on the wound.

The quotation ‘People who peek through key-holes have to expect an occasional poke in the eye’ comes to mind in view of the recently published LACC Trial in the New England Journal of Medicine showing significantly worse survival following ‘keyhole’ surgery (laparoscopic or robotic) in early stage cervical cancer (Ramirez et al. N Engl J Med 2018;379:1895–904). A second study in the same edition reinforced the results by also showing a worse survival with ‘keyhole’ surgery (Melamed et al. N Engl J Med 2018;379:1905–14). This must be considered to be as unfortunate as having ‘both eyes poked at the same time via the same keyhole’. Before gynaecological oncologists have regained full sight, comes this third publication focusing on fertility-sparing surgery in early stage cervical cancer which ‘rubs salt on the wound’ by also showing excellent survival with an abdominal approach. The study by Li et al. (BJOG 2019; 126:1169–74) the largest published series on abdominal radical trachelectomy (ART) demonstrating a 98.6% 5-year survival, agrees well with the abdominal arm in the LACC trial of 99% 3-year survival and contrasts significantly with the laparoscopic arm of 93.8% 3-year survival. In addition, the results are comparable to previous publications on ART and add substantially to the literature (previously, 866 cases with a cumulative mortality rate of 1.4%). Of interest are the results on tumours larger than 2 cm with a recurrence rate of 5.3% compared with 2.0% in tumours <2 cm (nonsignificant P value). Analysis of the New England Journal of Medicine publications identified that it was in this sub-group specifically there were the greatest differences in recurrences. It is also in this sub-group that survival differences are the greatest compared with vaginal radical trachelectomy (cumulative recurrence rate of 23.9%), which also utilises a laparoscopic approach (BJOG 2019;126:1169–74). Data following total laparoscopic radical trachelectomy are limited. Consistent with this, is the FIGO 2018 re-classification of cervix cancer reducing the cut-off between IB1 and IB2 tumours from 4 to 2 cm (Bhatla et al. Int J Gynaecol Obstet 2018;143 (Suppl 2):22–36). Where does all this leave us? Is the problem the surgeon or the tools or the procedure? Many are questioning the surgical techniques in order to retain a minimally invasive approach including the use of manipulators, the CO2 pneumoperitoneum, tumour exposure to the peritoneum and the surgical radicality. It's also time to reflect. Fertility-sparing or not, why have different surgeons/centres been advocating different surgical procedures/approaches? One explanation is the Collingridge dilemma stating that technological advances contain two components; (1) information: where the effects of technological advances cannot be predicted until they are extensively developed and widely used in clinical practice, and (2) power: where control (by the use of robust clinical evaluations) is difficult when the technology has become entrenched (Collingridge. The Social Control of Technology. London, UK: Palgrave Macmillan, 1981). This is highlighted by the Pacing problem, where innovations develop exponentially while control mechanisms develop incrementally. The solution would be the Precautionary principle, where innovations should not be embraced until developers can prove they will not cause harm. Critics argue this will not eliminate innovations developing in the wrong direction but result in no innovations developing at all. Although it is painful to have to revert back to an abdominal route, the solace is that ‘rubbing salt on the wound’, regardless of the additional pain, will help the wound recover faster. And so, for women with a stage IB2 cervical tumour (FIGO 2018) who wish to preserve fertility, the recommended operation should be an ‘abdominal’ radical trachelectomy. None declared. A completed disclosure of interests form is available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Short- and long term outcomes after abdominal radical trachelectomy versus radical hysterectomy for early stage cervical cancer: a systematic review of the literature and meta-analysis.

Cervical cancer (CC) ranks 2nd for mortality among women of reproductive age in the United States. Abdominal radical trachelectomy (ART) is a fertility sparing approach that has been proposed in women with early stage CC who wish to preserve their fertility. The aim of the present meta-analysis was to evaluate the short- and long-term outcomes of RH vs ART for early stage CC. A total of 5 electronic databases were searched for articles published up to December 2018. Prospective and retrospective trials reporting outcomes for women who underwent ART or RH for the management of early stages CC, were considered eligible for inclusion. Statistical meta-analysis was performed using the RevMan 5.3 software. A total of 5 studies which included 840 women who underwent ART or radical trachelectomy (RH) were included in the present meta-analysis. Among them, 324 underwent ART whereas the remaining 516 had RH. Despite the fact that ART was associated with significantly prolonged operative time compared to RH (840 patients MD 36.82min, 95% CI 20.15-53.49, p < 0.001), neither 5-year OS nor 5-year DFS were different among the two groups (714 patients OR 1.39, 95% CI 0.53-3.62, p = 0.51 and 682 patients OR 1.08, 95% CI 0.52-2.25, p = 0.84, respectively). ART is a more complex and time consuming technique, but equally safe compared to RH in terms of oncological outcomes for selected women with early stage CC and allows for more CC survivors of childbearing age to preserve their fertility.

The security of radical trachelectomy in the treatment of IA-IIA cervical carcinoma requires further evaluation: updated meta-analysis and trial sequential analysis.

The aim of this study was to assess the security of radical trachelectomy (RT) in the treatment of IA-IIA cervical carcinoma and conducted a new survey based upon the results of previous researches. The PMC, PubMed, Web of Science, Cochrane and EMBASE databases were retrieved to collect prospective clinical controlled trials (CCTs) published from 1984 to 2018. The oncologic outcomes were evaluated by meta-analysis, trial sequence analysis (TSA) and statistical analysis. Five prospective CCTs were collected in this study. The recurrence rate and mortality of RT was similar to that of radical hysterectomy (RH), which was consistent with the oncologic outcomes of meta-analysis and TSA. Patients with tumors 2-4cm in diameter were more likely to receive RH, which may be a potential factor in the higher rate of adjuvant chemotherapy in the this group, and RH was significantly associated with the risk of intraoperative blood transfusion. It is notable that considerable negative margin was achieved by radical abdominal trachelectomy (RAT), and the clinical effect of RAT was slightly better than that of radical vaginal trachelectomy (RVT). However, the TSA results showed that the cumulative cases were not up to the required sample size to obtain the true negative or positive results. It is safe and effective for early-stage patients with cervical cancer whose lesions are less than 2cm to receive RVT. For those patients with lesions 2-4cm who desire fertility preservation and without any evidence of infertility, RAT can be a feasible alternative to RH under fully informed consent. However, more CCTs with larger sample size are still required for further validation.

Reproductive outcomes following treatment for a gynecological cancer diagnosis: a systematic review.

Fertility treatments are available for women diagnosed with a gynecological malignancy, which is important for women who desire a biological family subsequent to treatment. The objective of this study was to report reproductive outcomes following fertility-sparing treatment for a gynaecological cancer. Electronic databases were searched to identify studies that reported on reproductive outcomes after treatment for a gynecological malignancy. In total, 77 studies were included which reported on reproductive outcomes after treatment for cervical cancer, endometrial cancer, gestational trophoblastic disease, and ovarian cancer. The main treatments included vaginal or abdominal radical trachelectomy, progestin therapy, salpingo-oophorectomy, and chemotherapy. The mean age at diagnosis for the study population and at birth were 30.5years and 30.3years, respectively. There were 4749 pregnancies (42%) reported for the included studies, with a miscarriage rate of 15% and a medical termination rate of 5%. The live birth rate was 74% with a 10% preterm rate. Patients should be offered timely discussions, information, and counseling regarding the impact of gynecological cancer treatment on a patient's fertility. Furthermore, fertility-sparing strategies and fertility preservation should be discussed prior to starting treatment.

Oncological results and recurrent risk factors following abdominal radical trachelectomy: an updated series of 333 patients.

To update the oncological results and identify recurrent risk factors in young patients with early stage cervical cancers following abdominal radical trachelectomy (ART). Retrospective study. A university-based cancer hospital. Three hundred and thirty-three patients. We conducted a retrospective analysis from a prospectively maintained database of patients undergoing ART from April 2004 to December 2017. Survival rate, clinicopathological factors related to recurrences. Two hundred and seventy-one patients had squamous carcinomas (SCC), 51 had pure adenocarcinomas (AC), and 11 had adenosquamous carcinomas (AS). One hundred thirty-two women (39.6%) had tumours ≥2cm. With a median follow up of 56months (range, 6-169), 11 patients (3.3%) had recurrence, and five patients (1.5%) died. The cumulative 5-year recurrence-free survival and overall survival rates were 96.3 and 98.6%, respectively. The recurrence rate in women with tumours ≥2cm was comparable to that in patients with tumours <2cm (5.3 versus 2.0%, respectively, P=NS). However, the recurrence rate was significantly higher in patients with AS histology than those with AC and SCC histology (18.2, 3.9, and 2.6%, respectively, P<0.05). All of the recurrent patients with AS histology had tumours ≥2cm. Multivariate analysis showed that the only independent risk factor for recurrence was histology type. This updated series showed a favourable survival rate following ART. These results further supported that ART was a safe option for well-selected patients with stage IB1 cervical cancers ≥2cm. However, if patients with tumours ≥2cm have AS histology, they should be advised with great caution when contemplating ART. Abdominal radical trachelectomy could be a safe, fertility-sparing option for strictly selected patients with stage IA1-IB1 cervical cancers ≤4cm.

Left fallopian tube prolapse after abdominal radical trachelectomy treated by laparoscopic left salpingectomy: A case report

Left fallopian tube prolapse after abdominal radical trachelectomy treated by laparoscopic left salpingectomy: A case report

Oncological and obstetric outcomes after fertility-sparing radical abdominal trachelectomy for early stage cervical cancer: a tertiary centre’s 10 years’ experience

The aim of this study is to present our clinical experience about fertility-sparing procedures in early stage cervical cancer and its obstetrical and oncological outcomes. Between the years 2006 and 2016, a total of 22 early stage cervical cancer patients who underwent a fertility-sparing radical abdominal trachelectomy in our clinic were retrospectively analysed. The median age was 33 (range: 28–39) years. The median follow-up was 47 (range: 22–125) months. Five patients (22.7%) had Stage IA1, three patients had (13.6%) Stage IA2, and 14 patients (63.6%) had Stage IB1 disease. Only one patient had a recurrence. A pregnancy was obtained in five patients (22.7%) and one of them (20%) had a live birth. A pregnancy was obtained spontaneously in two patients (40%), whereas assisted reproductive techniques were used in three of the patients (60%). A miscarriage occurred in two patients (40%), and one of them was within the first trimester and the other was within the second trimester.Impact statementWhat is already known on the subject? Currently, the first-line treatment of early stage cervical cancer is surgery. However, a fertility-sparing trachelectomy is the most widely adopted approach in the reproductive aged patients who have a desire to be pregnant later.What does this study add? In the literature, there is a growing number of studies on this subject. However, it would take time to obtain adequate knowledge. We believe that our study would contribute to the existing data.What are the implication of these findings for clinical practice? This study is important as it indicates that a multidisciplinary approach is required to preserve fertility among gynaecologic oncologists and the outcomes would be reflected into the clinical practice. In addition, we believe that our study would pave the way for further studies regarding this subject among oncologists.

Fertility sparing technique during pelvic exenteration for recurrent vaginal rhabdomyosarcoma

Abstract We present the first case and describe the surgical technique of anterior pelvic exenteration with uterine preservation in a 17-year-old patient with a recurrent vaginal rhabdomyosarcoma. Surgical technique included a skeletonization of uterine pedicles and ligation of superior vesical and vaginal arteries, adapting abdominal radical trachelectomy technique. Cervix was transected to avoid vaginal opening and tumor spillage. Uterus was reimplanted to a vaginal reconstruction, created with a DIEP, and a continent urinary diversion was performed. Pelvic filling was completed with an omental J-flap. Postoperative course was uneventful and the patient was discharged at day 17th. The last days of her stay were dedicated to self-catheterization education and learning the management of Miami pouch. Her menstrual cycle resumed two months after the surgery. Cervix exhibited a normal appearance during clinical examination eight weeks after surgery and postoperative MRI did not show signs of local recurrence. Unfortunately, distant metastatic relapse occurred three months after surgery and the patient died two months later. Fertility preservation at the time of anterior pelvic exenteration is technically feasible in selected young patients. Further cases are needed to assess the reproducibility of this surgical procedure, the reproductive function of the uterus and the rate of uterine recurrences.

Surgical and Oncologic Outcomes of Radical Abdominal Trachelectomy Versus Hysterectomy for Stage IA2-IB1 Cervical Cancer

To compare the surgical and oncologic outcomes between abdominal radical trachelectomy (ART) and radical hysterectomy (RH) for stage IA2-IB1 cervical cancer. A retrospective cohort study (Canadian Task Force classification II-2). Shandong Cancer Hospital, Shandong, China. Three hundred twenty-nine patients with IA2-IB1 cervical cancer. All patients underwent ART or RH. All patients were divided into ART (n = 143) and RH (n = 186) groups according to the surgical approach. Additionally, oncologic and fertility outcomes were compared for different tumor pathologies and sizes in ART patients. The ART group had similar case characteristics as the RH group, except that the ART group had a longer surgical time. During a similar follow-up period, there were 4 (2.9%) recurrences and 3 (2.2%) patients who died from recurrence in the ART group compared with 8 (4.6%) recurrences and 4 (2.3%) patients who died from recurrence in the RH group (p = .444 and p = .999, respectively). In the ART group, squamous cell carcinoma (SCC) patients had a 5-year overall survival and pregnancy rate similar to those of non-SCC patients (98.1% vs 96.8%, p = .999; 33.3% vs 26.7%, p = .873), and patients with tumors ≤2 cm and 2 to 4 cm experienced a similar 5-year overall survival rate (97.0% vs 98.6%, p = .999), except patients with tumors ≤2 cm had a higher pregnancy rate (45.2% vs 17.2%, p = .020). ART seems to have similar surgical and oncologic outcomes to RH, except ART has a longer surgical time. Both non-SCC patients and stage IA2-IB1 patients with 2- to 4-cm tumors can undergo ART safely. Patients with tumors ≤2 cm have a higher pregnancy rate than patients with 2- to 4-cm tumors.