Radical Trachelectomy For Cervical Cancer Research Articles

Round ligament suspension and vaginal purse-string suture: Newly optimized techniques to prevent tumor spillage in laparoscopic radical trachelectomy for cervical cancer.

The purpose of this study was to investigate the surgical techniques and clinical feasibility of nonuterine manipulator and enclosed colpotomy to avoid cancer cell spillages in laparoscopic radical trachelectomy (LRT) for patients with early-stage cervical cancer. We performed the newly optimized surgical techniques of round ligament suspension and vaginal purse-string suture in LRT in 12 patients with early-stage cervical cancer from May 2019 to October 2020. Surgical information and postoperative results were recorded. All 12 patients successfully underwent LRT with round ligament suspension and vaginal purse-string suture, and no conversion to laparotomy was required. The median operation time was 268.5min (range 200-320 min), including 5min of round ligament suspension, and the median blood loss was 20 mL (range 5-50 mL). The median number of pelvic lymph nodes removed was 27 (range 19-35), and median amounts of paracervical tissue was 24 mm (range 21-26 mm) and vaginal tissue was 18 mm (range 16-26 mm). No intraoperative complication or serious postoperative complications were reported. Round ligament suspension and vaginal purse-string suture techniques are feasible and effective in LRT. They can replace uterine manipulator and unprotected colpotomy with satisfactory perioperative outcomes.

Obstetric outcomes of radical trachelectomy for cervical cancer : a retrospective review

Obstetric outcomes of radical trachelectomy for cervical cancer : a retrospective review

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.

MRI measurement of residual cervical length after radical trachelectomy for cervical cancer and the risk of adverse pregnancy outcomes: a blinded imaging analysis.

To determine the association between the residual cervix measured on postoperative MRI after radical vaginal trachelectomy (RVT) and adverse obstetrical outcomes. Observational study. Referral Cancer centre. Women who conceived after RVT for cervical cancer at the Royal Marsden Hospital, London, between 1995 and 2015. Postoperative MRI scans were analysed by three researchers. The agreement between researchers was assessed by Pearson's correlation coefficient and Bland-Altman plot. Patients were divided into two groups (<10 and ≥10 mm residual cervix) for the analysis of adverse obstetrical outcomes. Late miscarriage, premature delivery, premature rupture of membranes (PROM) and chorioamnionitis. Thirty-one MRI scans were available; 29 of these women had a pregnancy that progressed beyond the first trimester. There was a strong reproducibility of the measurement of residual cervix (P < 0.001). Nineteen women (65.5%) had <10 mm residual cervix and 10 (34.5%) had ≥10 mm. Among women with <10 mm residual cervix, seven (36.8%) experienced PROM and ten (66.7%) had a preterm birth; No women with ≥10 mm residual cervix had PROM and two (22.2%) had a preterm birth (P = 0.028 and P = 0.035, respectively). Overall, there were nine (16.7%) first-trimester miscarriages, six (11.1%) late fetal losses, 12 (31.6%) preterm births and 36 (66.7%) live births. After a mean follow up of 78.1 months, 36 women were disease-free and one woman had died. MRI measurements of the residual cervix are reproducible between observers. The incidence of PROM and premature delivery is higher when the residual cervix after RVT is <10 mm. The risk of prematurity after RVT can be predicted from measurements of residual cervical length on postoperative MRI scan.

Role of cervical cytology in surveillance after radical trachelectomy for cervical cancer

ObjectiveThere are currently no standard guidelines on the use of Papanicolaou (Pap) tests for surveillance after radical trachelectomy for cervical cancer. The goal of this study was to determine the usefulness of Pap tests in routine surveillance after radical trachelectomy for cervical cancer. MethodsCervical cancer patients who underwent radical trachelectomy from January 2004 through October 2015 and subsequently had at least one Pap test were retrospectively identified. Demographic and clinical characteristics were described and compared between patients with and without at least one abnormal Pap test. The Kaplan-Meier method was used to estimate time to first abnormal Pap test. ResultsForty-one patients met inclusion criteria. Of these, 30 (73%) had at least one year in which more than one Pap test per year was obtained. Twenty-four (59%) had at least one abnormal Pap test. Of 238 total Pap tests collected, 44 (18%) were abnormal. The most common abnormality was ASCUS (52%, n=23). Other findings included LSIL (20%, n=9), HSIL (2%, n=1), and AGUS (25%, n=11). Median time from radical trachelectomy to first abnormal Pap test was 17.2months (range, 11.8–86.3). No patient had disease recurrence. Surgery type (laparoscopic, open, or robotic), trachelectomy specimen size, histology, device for stenosis prevention (pediatric Foley catheter or Smit Sleeve), and cerclage placement were not significant predictors of an abnormal Pap test. ConclusionsThe rate of abnormal Pap tests after radical trachelectomy is high; however, the clinical significance of such abnormalities appears limited. The routine use of cervical cytology as surveillance after radical trachelectomy does not appear to substantially impact management decisions.

Expanding radical trachelectomy for cervical cancer with tumor ≥ 2 centimeters: A report of 29 cases

Expanding radical trachelectomy for cervical cancer with tumor ≥ 2 centimeters: A report of 29 cases

Conservative Approach in Gynecologic Malignancies

Abstract Objective: This review was undertaken with the purpose of highlighting the options of a conservative approach in the management of gynecologic cancers so that clinicians exhibit some restraint before deciding on extensive surgeries as the management option. Background: Ovarian function and fertility are the main concerns while treating young women with gynecologic cancers. A conservative approach in management addresses these issues and aims at preserving the uterus and/or ovarian tissue. Early cervical and endometrial cancers, germ cell ovarian tumors, borderline ovarian tumors, and even early epithelial ovarian tumors are the gynecologic cancers where there is scope for a conservative approach. It may be in the form of radical trachelectomy for cervical cancer, medical (hormonal) treatment for endometrial carcinoma, or uterus/ovary-preserving surgeries for ovarian malignancies. On other end of the spectrum, there are advanced malignancies that may require extensive surgeries, which may further ...

Radical trachelectomy for cervical cancer: Postoperative physical and emotional adjustment concerns

Objective To investigate the incidence of cervical stenosis and related emotional and sexual adjustment concerns in women treated with radical trachelectomy. Methods Prospective data of 30 stage I cervical cancer patients enrolled in an ongoing study were evaluated in combination with a medical chart review. Results Eight patients (27%) did not have any stenosis of the neo-cervix postoperatively; 10 (33%) had clinically notable stenosis not requiring neo-cervical dilation to allow adequate sampling; moreover, 12 (40%) had sufficient stenosis requiring a neo-cervical dilation procedure, which proved to be safe and useful. The majority of the dilation procedures ( n = 8) were conducted under local anesthesia in the office. At preoperative baseline survey, women reported a high rate of sexual inactivity. Fear of intercourse and dyspareunia were reported prior to surgery; however, trends of adjustment and improvement were noted over time postoperatively. Overall, fear of sexual activity tended to lessen if the degree of dyspareunia decreased over time. Postoperative dyspareunia decreased over time, which could have been associated with the mechanical stretching due to vaginal dilator use or dilating benefit of intercourse. Conclusion Postoperative concerns associated with radical trachelectomy may be greater than what has been reported in the literature; however, several adjustment trends were noted with intermediate/long-term follow-up. Office cervical dilation is a simple procedure, which is helpful in the management of neo-cervical stenosis. We are currently investigating the value of a physician checklist as a clinical care model to remind medical professionals to monitor and address important survivorship issues.

Fertility preservation in patients with early cervical cancer: Radical trachelectomy

Objectives The goal of this review is to summarize the latest literature on the subject of radical trachelectomy and fertility outcomes in patients with early-stage cervical cancer. Methods We analyzed the published literature in search of all articles addressing surgical techniques, intraoperative and perioperative outcomes, and obstetrical results in patient undergoing radical trachelectomy for cervical cancer. Results It is estimated that 43% of all cases of cervical cancer in the United States are diagnosed in women younger than 45 years of age. As of 2007, a total of 520 patients had been reported to have undergone a radical vaginal trachelectomy. The majority of patients (60%) had a diagnosis of squamous cell carcinoma; adenocarcinoma was the second most common histologic subtype (40%). Data on outcomes after radical abdominal trachelectomy are less extensive—only approximately 50 cases have been reported worldwide. Approximately 43% of patients who undergo a radical trachelectomy subsequently attempt to become pregnant. Seventy percent of these women are successful at achieving a pregnancy. Conclusions Radical trachelectomy is safe and feasible and pregnancy outcomes are very favorable. All patients interested in future fertility who are diagnosed with cervical cancer are encouraged to discuss radical trachelectomy with their physician.

Management of Pregnancy after Radical Trachelectomy: Case Reports and Systematic Review of the Literature

This article reviews the existing literature on pregnancy outcomes following radical trachelectomy for low-stage cervical carcinoma and describes the guidelines in our institution for obstetrical management after managing two pregnancies following radical trachelectomy. We performed a literature search in PUBMED, MEDLINE, and EMBASE for the keywords "radical trachelectomy," "pregnancy," or "fertility" from 1994 to the present. All observational studies were included, and duplicate cases were excluded from our review. In addition to our cases, 14 studies were reviewed and included. Selection criteria included case reports or series detailing pregnancy outcomes including gestational age at delivery. Data regarding pregnancy outcomes were tabulated from the reports with focus on additional procedures such as vaginal occlusion and delivery outcomes. Where data were unclear, the authors personally contacted the authors of previously published manuscripts for further data. Our results revealed that 40% of women conceived following radical trachelectomy. Of them they had a preterm delivery rate of 25%, and 42% culminated in delivery of a live born infant at term. The use of the vaginal occlusion procedure did not appear to prolong gestation when compared with those women who did not have the procedure, but the majority of successful pregnancy outcomes have occurred with a cerclage in place. In conclusion, successful pregnancy outcome is possible after radical trachelectomy for cervical cancer, with two thirds of pregnancies resulting in a live birth, including those of both cases reported. There is a higher frequency of adverse perinatal outcomes in these patients, however, and careful interdisciplinary planning and counseling prior to undertaking the trachelectomy is recommended.

Reproductive concerns of women treated with radical trachelectomy for cervical cancer

To report the reproductive concerns of women treated for stage I cervical cancer with fertility-preserving surgery. Newly diagnosed cervical cancer patients undergoing radical trachelectomy were enrolled in this study preoperatively and assessed over time. Preliminary data from the preoperative analysis and 3-month and 6-month assessment points addressing reproductive concerns are presented. Between February 2004 and June 2006, 29 patients were enrolled in the study. Three patients were excluded because they did not undergo the planned surgery and 6 patients were excluded because they required adjuvant therapy. Future childbearing was the main reason most women chose to undergo the procedure; however, treatment choice was also guided by conversations with their doctors (41%, n=12). Twenty-six (90%) initially expressed concern over future conception and childbearing, but this increased to all patients by 6 months. At enrollment, the majority of the patients had high expectations for future conception and childbearing but this declined over time. Despite this, patients' distress gradually decreased over time. Our results show that many women who have undergone a radical trachelectomy present with distress and reproductive concerns that persist for up to 6 months postoperatively. Concerns about conception appear to decrease following surgery; however, concerns about pregnancy appear to increase post trachelectomy itself. This pilot study reflects the first preliminary data from an active ongoing study prospectively collecting information over 2 years from newly diagnosed stage I cervical cancer patients undergoing radical trachelectomy.

Isolated recurrence at the residual uterine cervix after abdominal radical trachelectomy for early cervical cancer

Background. We report an isolated recurrence at the residual cervix shortly after abdominal radical trachelectomy for cervical cancer. Case. A 34-year-old woman underwent radical abdominal trachelectomy and pelvic lymphadenectomy for FIGO stage IB1 squamous cell cervical cancer. The tumor measured 10 mm in maximum diameter with 4 mm of invasion. Histology showed lymph vascular space involvement with no infiltration of adjacent structures and no pelvic lymph node metastases. Tumor-free resection margins exceeded 15 mm. At the 6-month follow-up examination, cervical cytology showed cells suspicious for recurrent cervical cancer. Abdominal hysterectomy was performed and histology showed an isolated 3-mm recurrence in the residual cervix. The patient is free of disease 8 months after hysterectomy. Conclusion. Recurrence at the residual cervix is a potential risk of abdominal trachelectomy for early cervical cancer. Patients should be counseled accordingly and followed closely.