Trachelectomy Research Articles

Oncologic and Fertility Outcomes After Simple Trachelectomy in Women With Early Cervical Cancer

Study Objectiveto present our case series of patients with early-stage cervical cancer undergoing simple trachelectomy. Currently, radical trachelectomy is considered the most appropriate fertility preserving procedure for the treatment of early-stage cervical cancer. However, there is increasing debate on the appropriate radicality of the surgery in order to preserve oncologic safety. Designdescriptive retrospective analysis of patient records and evaluation of questionaires Settingtwo gynecologic oncologic centers, surgeries performed by one surgical team Patients36 women with early-stage cervical cancer undergoing simple trachelectomy Interventionslaparoscopic assisted simple vaginal trachelectomy MeasurementsDemographic, histological, fertility and follow-up data of all patients who underwent simple trachelectomy between 04/2007 and 7/2021 were prospectively recorded and retrospectively analyzed. Main Results36 women (mean age: 28 years) underwent simple trachelectomy of whom 81% were nulliparous. Indications for simple trachelectomy were multifocal FIGO stage IA1 (n=30), stage IA1 L1 (n=1), stage IA2 (n=2) and stage IB1 (n=3), respectively. Mandatory staging-procedure was laparoscopic pelvic lymphadenectomy, including bilateral sentinel-biopsy in 92% of the cases and systematic in 8%. Residual tumor was histologically confirmed in 8 specimens (22%). 18 women (50%) were seeking parenthood, 13 succeeded (72%). There were 16 live births, all on term, with a median fetal weight of 3110 (2330-4420) gram. One patient had a medical abortion due to fetal congenital malformation. One pregnancy is ongoing. After a median follow-up of 91.5 (9-174) months all women are alive with no evidence of disease. ConclusionSimple trachelectomy represents a de-escalation compared to radical trachelectomy and provides excellent oncologic results with an outstanding fertility rate and obstetrical outcome for patients with early cervical cancer. However, clear indications for this tailored fertility-preserving surgery have to be defined in well-designed trials.

Effect of radical trachelectomy on ovarian reserve: A single-institute prospective study.

Reduced responses to controlled ovarian stimulation (COS) after radical trachelectomy (RT) have been previously reported. We aimed to assess the effect of RT on ovarian reserve by measuring anti-Müllerian hormone (AMH) levels before and after the procedure in this prospective study. We included 12 patients who underwent RT between September 2019 and December 2021 in this study. Serum AMH levels were measured preoperatively, 1 month postoperatively, and 6 months postoperatively. Differences in the AMH levels were assessed using a paired t-test. The median age of the patients was 30.6 years, and the median follow-up time was 30.1 months. AMH levels at 1 and 6 months postoperatively did not show a consistent trend. At 1 month postoperatively, the average AMH level decreased insignificantly but returned to preoperative levels at 6 months. The differences in AMH levels before and after RT were insignificant. Our findings indicate that RT did not affect ovarian reserve as measured by AMH levels. However, the relationship between unchanged ovarian reserve and reduced response to COS remains unclear. Further research with larger sample sizes and additional measures of ovarian function is needed to corroborate these results and investigate the long-term effects of RT on ovarian reserve. Understanding these mechanisms will help guide surgical practices and provide patients with valuable information about their reproductive outcomes after RT.

An update of oncologic and obstetric outcomes of radical trachelectomy for early-stage cervical cancer: The need for further minimally invasive treatment.

To investigate the oncologic and obstetric outcomes of radical trachelectomy (RT) in patients with early-stage cervical cancer and to evaluate the potential role of fertility-preserving treatments in improving pregnancy outcomes while oncologic status is stable. In this single-institution study, we analyzed the oncologic and obstetric outcomes of 67 patients with early-stage cervical cancer who underwent RT at Nagoya University Hospital. The cancer recurrence rate (6.0%) and the mortality rate (1.5%) were comparable with those of previous studies. Of the 46 patients who attempted to conceive after RT, 19 (41.3%) became pregnant, and 16 gave birth. Of these 37.5% delivered at term, and delivery at less than 28 weeks of gestation occurred in 31.3% of pregnancies. RT is a viable treatment option for selected patients with early-stage cervical cancer. However, the use of less invasive techniques, such as conization/simple trachelectomy and pelvic lymph node dissection, may improve pregnancy outcomes while oncologic status is stable.

A case report of cervical cancer stage Ib2 treated with radical trachelectomy

We present the case of a 34-year-old woman, with cervical cancer Stage IB2, treated with radical trachelectomy (and bilateral lymphadenectomy) instead of radical hysterectomy. Recurrence of the disease was diagnosed just a few months after the initial operation. Although the woman's desire was the preservation of fertility, it should be emphasized that best cancer treatment according to stage, is necessary to not endanger the patients’ life.

A meta-analysis of treatment for early-stage cervical cancer: open versus minimally invasive radical trachelectomy

BackgroundIn previous systematic reviews, meta-analysis was lacking, resulting in the statistical difference between the data of different surgeries being impossible to judge. This meta-analysis aims to contrast the fertility results and cancer outcomes between open and minimally invasive surgery.MethodWe systematically searched databases including PubMed, Embase, Cochrane, and Scopus to collect studies that included open and minimally invasive radical trachelectomy. A random-effect model calculated the weighted average difference of each primary outcome via Review Manager V.5.4.ResultEight studies (1369 patients) were incorporated into our study. For fertility results, the Open group excels MIS group in pregnancies-Third trimester delivery [OR = 2.68; 95% CI (1.29, 5.59); P = 0.008]. Nevertheless, there is no statistical difference in clinical pregnancy, miscarriage, and second-trimester rate. Concerning cancer outcomes, no difference was detected in the overall survival [OR = 1.56; 95% CI (0.70, 3.45); P = 0.27] and recurrence [OR = 0.63; 95% CI (0.35, 1.12); P = 0.12]. Concerning surgery-related outcomes, the comprehensive effects revealed that the estimated blood loss of the Open group was higher than that of the MIS group[MD = 139.40; 95% CI (79.05, 199.75); P < 0.0001]. However, there was no difference between the postoperative complication rate in the two groups [OR = 1.52; 95% CI (0.89, 2.60); P = 0.12].ConclusionThis meta-analysis suggested that the fertility result of the Open group may be better than the MIS group, while the MIS group has better surgery-related outcomes. Owing to the poor cases of our study, a more robust conclusion requires more relevant articles in the future.Systematic review registrationPROSPERO CRD42022352999.

Quality of breaking bad news to patients diagnosed with neoplasia of the uterine cervix

ObjectiveLittle is known about the quality of receiving bad news (BN) for women diagnosed with cervical neoplasia. We evaluated adherence to the SPIKES protocol in three cohorts of women with different stages of the disease and treatment modalities.Patients and methodsWe included women with cervical cancer who underwent radical vaginal trachelectomy (RVT group, n = 110), radical hysterectomy or chemo-radiation (HE/RCT group, n = 101), and women with CIN 3 treated by loop excision (CIN group, n = 108). We asked the participants about how they received the bad news delivery in reality and how they would envision an ideal communication process based on the main items of the SPIKES protocol. The participants filled out a questionnaire with 38 items of the Marburg Breaking Bad News (MABBAN) Scale representing the six SPIKES subscales.ResultsOnly 72% of all patients reported being satisfied with their BBN experience. The following factors were considered important by 90% of the patients: an undisturbed atmosphere, taking enough time, coherent explanation of the disease, and the possibility to ask questions. However, the reality of their experiences fell significantly short of their expectations. Asking about the patient’s knowledge of the disease, addressing their concerns, allowing them to show emotions, providing clarity about the change in quality of life, informing them about alternative therapies, and involving them in further planning were also significantly lacking in the actual BBN encounters compared to the patients’ preferences. The experience of RVT patients was more negative compared to the HE/RCT patients (p = 0.036). The CIN patients had an overall satisfactory impression (p < 0.0001).ConclusionThe process of breaking bad news in German women diagnosed with cervical neoplasia requires substantial improvement. The SPIKES protocol can be used as a guideline for enhancement but should be supplemented by incorporating a second consultation as the norm rather than the exception. Continuous monitoring and improvement of the quality of BBN is recommended for all oncologic institutions, utilizing the MABBAN questionnaire as a valuable tool.

EP20.16: Reproductive and obstetric outcomes after radical trachelectomy in patients with early invasive uterine cervical cancer

EP20.16: Reproductive and obstetric outcomes after radical trachelectomy in patients with early invasive uterine cervical cancer

Pregnancy Through Assisted Conception After Radical Trachelectomy: A Case Report

Introduction: Trachelectomy, a conservative surgery in the early stages of cervical cancer, allows young women to keep their fertility. Infertility after such a surgery is frequent, and many couples should opt for assisted reproduction. Objectives: This case report aims to present a successful pregnancy in a woman with a history of cervical cancer and complete removal of the uterine cervix through trachelectomy. Case Presentation: A successful pregnancy is described after two failed attempts of embryo transfer (ET) in a 32-year-old woman with a history of trachelectomy due to stage IA invasive squamous cell carcinoma of the cervix. Before and after radical trachelectomy, she received adjuvant chemotherapy. In her second course of in-vitro fertilization, after a mock transfer at the time of ovum pickup with 11 oocytes and 7-day 3 embryos, her third ET cycle under ultrasound guide was successful. During pregnancy, in the first-trimester screening, nuchal translucency was reported to be 4.5 mm. Therefore, chorionic villous sampling and comparative genomic hybridization CGH-Array were performed before preparing for abdominal cerclage at 14 weeks. Further screening tests were normal. Finally, she delivered a 2430 g healthy baby girl through cesarean section at 37 weeks. Conclusions: The mock transfer and ultrasound-guided ET are suggested for women with a history of trachelectomy.

Fertility sparing therapy in women with lymph node negative cervical cancer >2cm – oncologic and fertility outcomes of neoadjuvant chemotherapy followed by radical vaginal trachelectomy

ObjectiveSimple or radical trachelectomy are accepted fertility sparing therapies for patients diagnosed with cervical cancer ≤2 cm. In patients with larger tumors a fertility sparing concept is considered experimental. The...

FD-2, an Anticervical Stenosis Device for Patients Undergoing Radical Trachelectomy or Cervical Conization.

This study aimed to introduce FD-2, a newly developed anticervical stenosis device for patients with cervical cancer undergoing radical trachelectomy. Using ethylene-vinyl acetate copolymers, we developed FD-2 to prevent uterine cervical stenosis after radical trachelectomy. The tensile test and extractables and leachables testing were performed to evaluate FD-2's safety as a medical device. FD-2 was indwelled in three patients with cervical cancer during radical trachelectomy and its utility was preliminarily evaluated. FD-2 consists of a head (fish-born-like structure), neck (connecting bridges), and body (tubular structure); the head is identical to FD-1, an intrauterine contraceptive device. FD-2 passed the tensile test and extractables and leachables testing. The average time required for the application or removal of FD-2 in cervical cancer patients was less than 10 s. The median duration of FD-2 indwelling was 8 weeks. No complications, including abdominal pain, pelvic infections, or hemorrhages, associated with FD-2 indwelling were reported. At the 3-12-month follow-up after the radical trachelectomy, no patients developed cervical stenosis or experienced dysmenorrhea. In conclusion, we developed FD-2, a novel device that can be used for preventing cervical stenosis after radical trachelectomy for uterine cervical cancer.

Fertility-preserving radical trachelectomy for early-stage cervical cancer in a young woman at Bugando Medical Centre in Mwanza, Tanzania: A case report

For women with early cervical cancer who wish to preserve their fertility, radical trachelectomy is the recommended procedure. More than 40% of all instances of cervical cancer occur in women of reproductive age

Pregnancy outcomes following radical trachelectomy for early-stage cervical cancer: A retrospective observational study in the Kanto area, Japan.

The authors aimed to investigate the prevalence of pregnancy and obstetric outcomes in patients who underwent radical trachelectomy (RT) for early-stage cervical cancer in the Kanto area, Japan. A survey among 113 perinatal centers affiliated with the Kanto Society of Obstetrics and Gynecology was conducted to investigate their experience in managing pregnancies following RT, between 2010 and 2020. The association between preterm delivery (before 34 gestational weeks) and a midtrimester short cervix (<13 mm) was evaluated. The authors retrospectively collected maternal and perinatal data from 13 hospitals. There were 135 pregnancies among 115 women following RT. Of the 135 pregnancies, 32 were miscarriages (<12 gestational weeks: n = 22; >12 gestational weeks: n = 10), and 103 were delivered after 22 gestational weeks. The incidences of preterm delivery before 28 and 34 gestational weeks were 8.7% and 30.1%, respectively. A midtrimester short residual cervix was associated with preterm delivery (P = 0.046). Since more than 100 pregnancies were recorded after RT in the Kanto area, many physicians had more opportunities to manage pregnancy after RT. Pregnancy following RT is associated with increased risk of preterm delivery, and midtrimester short residual cervix is a good predictor of preterm delivery.

Conservative treatment of cervical cancer: A single center experience over a two-decade period

ObjectiveTo report the surgical, oncological, and obstetrical outcomes of the different surgical techniques used for the fertility-sparing treatment of patients with early-stage cervical cancer. MethodsWe retrospectively analyzed all fertility-sparing procedures performed between 2004 and 2020. The study included patients desiring to preserve fertility who had squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma histology, all grades, and FIGO 2009 stage IA2-IB1 tumors. Results48 patients met the inclusion criteria. Eight patients (16.7%) had stage IA2, and 40 (83.3%) had stage IB1 tumors. Conization with pelvic lymph node assessment was performed in 5 (10.4%) patients, an open radical trachelectomy in 21 (43.8%), and a laparoscopic radical trachelectomy in 22 (45.8%). No major intraoperative complications were registered. Two patients required surgery due to an early postoperative complication. Late postoperative complications were seen in 15 patients (31.2%), with cervical stenosis being the most frequent (60%). The rate of DFS at 2 and 5 years was 89% (95% CI, 76–95%), and the 5- year OS was 96% (95% CI, 83–98%). Univariate analysis demonstrated a relationship between tumor size and recurrence, but not for other prognostic tumor factors or surgical approach. One patient (4.8%) developed recurrent disease in the open radical trachelectomy group, and five (22.7%) in the laparoscopic radical trachelectomy group. The pregnancy rate was 41.4%, and the live birth rate 88.2%. ConclusionFertility-sparing treatment for patients with early-stage cervical cancer is ever-evolving. This study adds information to the literature about the outcomes of these quite uncommon procedures, and allows a critical analysis of many of the topics which are under discussion.

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.

AMIGO2 expression as a predictor of recurrence in cervical cancer with intermediate risk.

Patients with recurrent cervical cancer have limited treatment options and are often considered to be incurable. Since the expression of amphoterin-induced gene and open reading frame 2 (AMIGO2) in clinical samples is a prognostic factor for colorectal cancer and gastric cancer, the present aimed to elucidate whether it is also a prognostic factor for cervical cancer. Patients with primary cervical cancer who underwent radical hysterectomy or radical trachelectomy at our institution (Faculty of Medicine, Tottori University, Yonago, Japan) between September 2005 and October 2016 were retrospectively collected. Immunohistochemical analysis using a specific antibody against AMIGO2 was performed on 101 tumor samples, and the clinical characteristics, disease-free survival (DFS) and overall survival (OS) of the patients were examined. Patients in the AMIGO2-high group had a shorter 5-year DFS and OS than those in the AMIGO2-low group (P<0.001). Furthermore, AMIGO2 was an independent prognostic factor for DFS in multivariate analysis (P=0.0012). Patients in the AMIGO2-high group exhibited obvious recurrence compared with those in the AMIGO2-low group in the high-(P=0.03) and intermediate-risk groups (P=0.003). Positive lymph node metastasis, and parametrial, stromal and lymph vascular space invasion were significantly more common in AMIGO2-high patients. Taken together, AMIGO2 expression may be a predictive marker of recurrence for cervical cancer. In particular, it may be an indicator to determine the need for postoperative adjuvant therapy in intermediate-risk group patients.

Radical Vaginal Hysterectomy, Type B: An Educational Video, Cadaver Model.

The radical vaginal hysterectomy popularized by Schauta1 has been virtually abandoned due to painful perineal incision, high rate of urinary dysfunction, and inability to perform lymph node assessment. However, this approach is still used and taught in a few centers outside its Austrian birthplace. In addition, a combined vaginal and laparoscopic approach, overcoming the flaws of the pure vaginal technique, was developed in the 1990s by French and German surgeons.2 After the publication of the Laparoscopic Approach to Cervical Cancer trial,3 the radical vaginal approach has found a very timely application with the closure of the vaginal cuff, aiming at avoiding cancer cell spillage.4 In addition, it is the basis to perform radical vaginal trachelectomy, or Dargent's operation, the best documented approach for the fertility-sparing management of stage IB1 cervical cancers. Today, the main obstacle to the rebirth of radical vaginal surgical surgery is the lack of teaching centers and the need of a specific learning curve that requires performing 20-50 surgeries.5,6 This educational video demonstrates that training is possible using a fresh cadaver model. A type B approach according to the Querleu-Morrow7 classification of radical vaginal hysterectomy, adapted according to surgeon's choice to stage IB1 or IB2 cervical cancer, is shown. Key specific steps such as the creation of a vaginal cuff and the identification of the ureter within the bladder pillar are highlighted. Fresh cadaver model is a method that spares the patients the risks of early learning curve while allowing the surgeon to acquire skills and keep offering the patient the benefit of the most specifically gynecological approach in cervical cancer surgery.

Performing a radical trachelectomy with uterine transposition in a patient with stage IB2 cervical cancer: A case report

We describe a case of a woman with invasive IB2 cervical cancer who desired to maintain fertility and required complex treatment. The suggested surgical approach with uterine transposition improves the existing radical trachelectomy procedure. Oncologic outcomes are encouraging, and no perioperative complications were noted. This report may represent a “milestone” in fertility-sparing surgeries, supporting the feasibility and safety of the opted method in stage IB2 cervical cancer with tumors about or smaller than 2 cm.

An update of oncologic and obstetric outcomes after abdominal trachelectomy using the FIGO 2018 staging system for cervical cancer: a single-institution retrospective analysis.

To apply the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system to all patients who underwent trachelectomy in our previous study and to update the oncologic and obstetric results. We retrospectively reviewed the medical records of patients in whom abdominal trachelectomy was attempted between June 2005 and September 2021. The FIGO 2018 staging system for cervical cancer was applied to all patients. Abdominal trachelectomy was attempted for 265 patients. Trachelectomy was converted to hysterectomy in 35 patients, and trachelectomy was completed successfully in 230 (conversion rate: 13%). Applying the FIGO 2018 staging system, 40% of the patients who underwent radical trachelectomy had stage IA tumors. Among 71 patients who had tumors measuring ≥2 cm, 8 patients were classified as stage IA1 and 14 as stage IA2. Overall recurrence and mortality rates were 2.2% and 1.3%, respectively. One hundred twelve patients attempted to conceive after trachelectomy; 69 pregnancies were achieved in 46 patients (pregnancy rate: 41%). Twenty-three pregnancies ended in first-trimester miscarriage, and 41 infants were delivered between gestational weeks 23 and 37; 16 were deliveries at term (39%) and 25 were premature deliveries (61%). This study suggested that patients judged to be ineligible for trachelectomy and patients receiving overtreatment will continue to appear using the current standard eligibility criteria. With the revisions to the FIGO 2018 staging system, the preoperative eligibility criteria for trachelectomy, which were based on the FIGO 2009 staging system and tumor size, should be changed.

Tralucent and Pellucid-Clear Cell Adenocarcinoma Uterine Cervix

Clear cell adenocarcinoma of uterine cervix is predominantly comprised of clear cells or hobnail cells articulating distinct architectural patterns as solid, tubulocystic or papillary. Tumour cell cytoplasm is clear, eosinophilic with intracytoplasmic hyaline globules and enhanced nuclear grade. A historic association with intrauterine diethylstilbestrol (DES) exposure is enunciated. Sporadic overexpression of p53 tumour suppressor gene may be observed. Neoplasm manifests with vaginal bleeding, postcoital bleeding or abnormal vaginal discharge. Cytological smears exhibit sheets, clusters or papillae of tumour cells permeated with delicate, vacuolated, glycogen rich or finely granular cytoplasm, enlarged, pale, spherical nuclei with prominent nucleoli or naked nuclei with tigroid background composed of granular, reticulated substance. Clear cell adenocarcinoma appears immune reactive to pan-cytokeratin as AE1 / AE3, CAM5.2, CK7, CK8, CK18, CK19, HNF1β, Napsin A, Ki67 or epithelial membrane antigen (EMA). Tumefaction requires segregation from neoplasms such as microglandular hyperplasia, Arias-Stella reaction, primary alveolar soft part sarcoma, mesonephric adenocarcinoma, metastatic clear cell renal cell carcinoma, endometrioid carcinoma, serous carcinoma, squamous cell carcinoma, urothelial carcinoma, adenosis, endometrioid adenocarcinoma with clear cell or secretory change, gastric subtype of endocervical adenocarcinoma or yolk sac tumours of uterine cervix. Neoplasm may be preliminarily subjected to radical hysterectomy with pelvic lymphadenectomy or fertility sparing radical trachelectomy.

TREATMENT OPTION TO THEFERTILITY-SPARING RADICAL TRACHELECTOMY AFTER NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH CERVICAL CANCER WITH TUMOR SIZE >2CM.

Radical trachelectomy combined with pelvic lymphadenectomy (PLND) has been used to treat early stage cervical cancer patients who wish to preserve their fertility. But vaginal, abdominal, laparoscopic, and robotic approaches used for radical trachelectomy with pelvic PLND cause peritoneal damage, which could result in periadnexal adhesion. Here, we propose theneoadjuvant platinum based chemotherapy (NACT) with thevaginal radical trachelectomy with retroperitoneal PLND as a fertility-preserving option for early stage cervical cancer patients. VRT with retroperitoneal PLND was performed in three women with FIGO 2018stage IB2and IIA1cervical cancers. In all three patients, complete response was achieved without causing any intraoperative and severe postoperative complications. NACT for fertility sparing treatment is an innovative approach, which is potentially quite interesting for many young women affected by cervical cancer with thetumor size >2cm. Vaginal radical trachelectomy with retroperitoneal PLND can be safely performed and peritoneal damage, which can cause periadnexal adhesion, could be avoided. We consider that this surgical approach and NACT may be a good treatment option for women with cervical cancer who wish to preserve their fertility.