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Terzic M, Makhadiyeva D, Bila J, Andjic M, Dotlic J, Aimagambetova G, Sarria-Santamera A, Laganà AS, Chiantera V, Vukovic I, Kocijancic Belovic D, Aksam S, Bapayeva G, Terzic S. Reproductive and Obstetric Outcomes after Fertility-Sparing Treatments for Cervical Cancer: Current Approach and Future Directions. J Clin Med 2023; 12:jcm12072614. [PMID: 37048696 PMCID: PMC10095321 DOI: 10.3390/jcm12072614] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
Cervical cancer is one of the leading causes of cancer-related death in women of reproductive age. The established fertility-sparing approaches for the management of early-stage cervical cancer for women who plan pregnancy are associated with a decline in fecundity and an increased risk of pregnancy complications. This article aims to offer an overview of fertility-sparing approaches and the management of potential subfertility and pregnancy complications after these treatments. An extensive search for the available data about infertility and cervical cancer, fertility-sparing techniques in patients with cervical cancer, fertility treatment, obstetrical complications, and pregnancy outcomes in cervical cancer patients was completed. Fertility-preserving procedures such as loop electrosurgical excision procedure (LEEP), cold-knife conization, and trachelectomy in women diagnosed with cervical cancer can be considered as safe and effective treatments that preserve reproductive potential. Current fertility-preserving procedures, based on the balance of the oncological characteristics of patients as well as their desire for reproduction, allow one to obtain acceptable reproductive and obstetric outcomes in women treated for cervical cancer. Nevertheless, careful monitoring of pregnancies obtained after fertility-preserving procedures is recommended, since this cohort of patients should be considered at higher risk compared with a healthy population.
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Affiliation(s)
- Milan Terzic
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana 010000, Kazakhstan
- Clinical Academic Department of Women’s Health, National Research Center for Maternal and Child Health, Corporate Fund “University Medical Center”, Turan Ave. 32, Astana 010000, Kazakhstan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Dinara Makhadiyeva
- School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana 010000, Kazakhstan
| | - Jovan Bila
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Mladen Andjic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
| | - Jelena Dotlic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Gulzhanat Aimagambetova
- Department of Surgery, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana 010000, Kazakhstan
- Correspondence:
| | - Antonio Sarria-Santamera
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana 010000, Kazakhstan
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Ivana Vukovic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Dusica Kocijancic Belovic
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Slavica Aksam
- Clinic of Obstetrics and Gynecology, University Clinical Centre of Serbia, Dr Koste Todorovica 26, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Dr Subotica Starijeg 8, 11000 Belgrade, Serbia
| | - Gauri Bapayeva
- Clinical Academic Department of Women’s Health, National Research Center for Maternal and Child Health, Corporate Fund “University Medical Center”, Turan Ave. 32, Astana 010000, Kazakhstan
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street, 5/1, Astana 010000, Kazakhstan
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Chen T, Li J, Zhu Y, Lu AW, Zhou L, Wang JS, Zhang Y, Wang JT. The oncological and obstetric results of radical trachelectomy as a fertility-sparing therapy in early-stage cervical cancer patients. BMC Womens Health 2022; 22:424. [PMID: 36289488 PMCID: PMC9608899 DOI: 10.1186/s12905-022-01990-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose This study explored the oncological and obstetric results of radical trachelectomy (RT) in early-stage cervical cancer patients. Methods A retrospective analysis was conducted the oncological and obstetric results of 23 patients with early cervical cancer (stages IA2–IB3; International Federation of Gynecology and Obstetrics, 2018) who underwent RT in The Maternal and Child Health Care Hospital of Guiyang, China, from October 2004 to September 2018. Results 23 patients had cervical tumors of the squamous cell carcinoma histological type. All 23 patients retained reproductive function. The mean follow-up time was 112.87 ± 55.75 (36–199) months. The median tumor size was 2.00 ± 1.35 cm (imperceptible to the eyes 5.00 cm). No recurrence was observed in any of the patient cases. Among the patients with a tumor size > 4 cm (up to 5 cm), three patients who wished to preserve fertility accepted RT following neoadjuvant chemotherapy The pregnancy outcomes were as follows: 8 cases (47.06%) out of 17 cases who attempting pregnancy conceived 12 times.First-trimester abortion and the voluntary abandonment of pregnancy occurred in 4 cases (33.33%), respectively, one patient performed deliberate termination at 24 weeks of gestation. Second-trimester abortion occurred in three cases (25.0%) for chorioamnionitis. Premature delivery at 32 weeks occurred in one case (8.33%). Conclusion Radical trachelectomy is a safe and effective treatment for women with early-stage cervical cancer preserving fertility biology. Patients with a cervical tumor sized > 4 cm can be pregnant after neoadjuvant chemotherapy and RT. Accordingly, this treatment is worthy of further exploration.
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Affiliation(s)
- Tao Chen
- Department of Gynecology, Maternal and Child Health Care Hospital of Guiyang, NO.63 Ruijin South Road, 561000 Guiyang, Guizhou China
| | - Jia Li
- Department of Gynecology, Maternal and Child Health Care Hospital of Guiyang, NO.63 Ruijin South Road, 561000 Guiyang, Guizhou China
| | - Yan Zhu
- Department of Gynecology, Maternal and Child Health Care Hospital of Guiyang, NO.63 Ruijin South Road, 561000 Guiyang, Guizhou China
| | - An-Wei Lu
- grid.284723.80000 0000 8877 7471Department of Gynecology, Shenzhen Hospital Affiliated to Southern Medical University, NO.1333 Xinhu Road, 518000 Shenzhen, China
| | - Li Zhou
- grid.284723.80000 0000 8877 7471Department of Gynecology, Shenzhen Hospital Affiliated to Southern Medical University, NO.1333 Xinhu Road, 518000 Shenzhen, China
| | - Jian-San Wang
- Department of Gynecology, Maternal and Child Health Care Hospital of Guiyang, NO.63 Ruijin South Road, 561000 Guiyang, Guizhou China
| | - Ying Zhang
- Department of Reproductive Center, Maternal and Child Health Care Hospital of Guiyang, NO.63 Ruijin South Road, 561000 Guiyang, Guizhou China
| | - Jun-Tao Wang
- Department of Gynecology, Maternal and Child Health Care Hospital of Guiyang, NO.63 Ruijin South Road, 561000 Guiyang, Guizhou China
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Saito T, Matsuura M, Tamate M, Iwasaki M, Mariya T. Radical Vaginal Trachelectomy. Surg J (N Y) 2021; 7:S103-S107. [PMID: 35111936 PMCID: PMC8799313 DOI: 10.1055/s-0041-1739120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
AbstractRecently, 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.
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Affiliation(s)
- Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Motoki Matsuura
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Masato Tamate
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Masahiro Iwasaki
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Tasuku Mariya
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
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Vaginal delivery after robot-assisted uterine artery-preserving radical trachelectomy for early-stage cervical cancer. Obstet Gynecol Sci 2021; 64:317-321. [PMID: 33539686 PMCID: PMC8138075 DOI: 10.5468/ogs.19127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/28/2020] [Indexed: 11/28/2022] Open
Abstract
Radical trachelectomy is conducted in women with early stage cervical cancer who strongly desire fertility preservation. To improve fertility outcomes, the preservation of the uterine artery has been suggested, which can be feasible by minimally invasive surgery using laparoscopy or robots. Although cesarean delivery is required for maternal and fetal health, vaginal delivery is a concern due to the fast delivery process of risk of preterm labor. We report a case of a 32-year-old nulliparous woman with stage IB1 cervical cancer who underwent robot-assisted uterine artery-preserving radical trachelectomy for improving fertility. This case is meaningful because she delivered by vaginal delivery after incision of the fibrotic ring at the level of uterovaginal anastomosis because delivery proceeded too quickly prior to the preparation of the cesarean delivery.
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Somigliana E, Mangili G, Martinelli F, Noli S, Filippi F, Bergamini A, Bocciolone L, Buonomo B, Peccatori F. Fertility preservation in women with cervical cancer. Crit Rev Oncol Hematol 2020; 154:103092. [PMID: 32896752 DOI: 10.1016/j.critrevonc.2020.103092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/15/2020] [Accepted: 08/17/2020] [Indexed: 12/16/2022] Open
Abstract
Fertility preservation in women with cervical cancer is a demanding but evolving issue. Some remarkable achievements have been reached, in particular the improvement of primary and secondary prevention and the broadening of the indications for conservative surgery up to FIGO 2018 stage IB2. Natural pregnancy rate and the rate of obstetrics complications following conservative approach is satisfactory even if not optimal. On the other hand, the use of classic strategies for fertility preservation such as oocytes or ovarian cortex freezing is extremely limited, being the uterus compromised by treatment in a high proportion of cases. In fact, the availability of uterine surrogacy can play a role in the counseling and the decision-making process. The recent advent of uterus transplantation is fascinating but, at present, cannot be viewed as a realistic solution.
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Affiliation(s)
- Edgardo Somigliana
- Dept of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Obstet-Gynecol Dept, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giorgia Mangili
- Obstet-Gynecol Dept, San Raffaele Scientific Institute, IRCCS Milan, Italy
| | - Fabio Martinelli
- Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Milan, Italy
| | - Stefania Noli
- Dept of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Fertility and Procreation Unit, Division of Gynaecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesca Filippi
- Obstet-Gynecol Dept, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alice Bergamini
- Obstet-Gynecol Dept, San Raffaele Scientific Institute, IRCCS Milan, Italy
| | - Luca Bocciolone
- Obstet-Gynecol Dept, San Raffaele Scientific Institute, IRCCS Milan, Italy
| | - Barbara Buonomo
- Fertility and Procreation Unit, Division of Gynaecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Fedro Peccatori
- Fertility and Procreation Unit, Division of Gynaecologic Oncology, European Institute of Oncology IRCCS, Milan, Italy
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Šimják P, Cibula D, Pařízek A, Sláma J. Management of pregnancy after fertility-sparing surgery for cervical cancer. Acta Obstet Gynecol Scand 2020; 99:830-838. [PMID: 32416616 DOI: 10.1111/aogs.13917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/17/2020] [Accepted: 05/12/2020] [Indexed: 12/14/2022]
Abstract
Cervical cancer is increasingly diagnosed in women who have not yet completed their reproductive plans. For women with early-stage disease (FIGO stage IA1-IB1), fertility-sparing procedures, such as conization, trachelectomy or radical trachelectomy, represent the treatments of choice. However, women who undergo repeated conization or trachelectomy represent a challenge for obstetricians because they are at increased risk of infertility, mid-trimester miscarriage, preterm premature rupture of membranes and preterm delivery. So far, the evidence-based guidance on the management of these pregnancies is limited. This article reviews the literature discussing pregnancy management in women after fertility-sparing surgery for early cervical cancer. Although the evidence is limited, certain measures are desirable, including screening and treatment of asymptomatic bacteriuria, screening for cervical incompetence and progressive cervical shortening by transvaginal ultrasonography, and fetal fibronectin testing. Vaginal progesterone supplementation should be primary prevention for all women after trachelectomy. Women with a history of preterm delivery or late miscarriage may benefit from cervical cerclage. Elective delivery by cesarean section in the early-term period is desirable.
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Affiliation(s)
- Patrik Šimják
- Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - David Cibula
- Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Antonín Pařízek
- Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jiří Sláma
- Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Umemoto M, Ishioka S, Mizugaki Y, Fujibe Y, Mariya T, Kawamata A, Mizuuchi M, Morishita M, Baba T, Saito T. Obstetrical prognosis of patients who underwent vaginal radical trachelectomy during pregnancy. J Obstet Gynaecol Res 2019; 45:1167-1172. [PMID: 31044479 DOI: 10.1111/jog.13964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 03/02/2019] [Indexed: 11/30/2022]
Abstract
AIM Radical trachelectomy (RT) with pelvic lymphadenectomy has become an option for young patients with early invasive uterine cervical cancer who decide to maintain their fertility. However, this operative method entails a high risk for the following pregnancy due to its radicality. Therefore, RT for pregnant patients can be a challenge both for gynecologic oncologists and obstetricians. METHODS We have performed vaginal RT for five pregnant patients with uterine cervical cancer stage 1B1 according to the method of Dargent et al. The operations were performed between 16 and 26 weeks of pregnancy, and the patients were followed up carefully according to the follow-up methods we reported previously. RESULTS Vaginal RT was performed for five patients without any troubles. Four of the patients continued their pregnancies until almost 34 weeks or longer under our previously published follow-up schedule. The pregnancy of one patient was terminated at 26 weeks due to recurrence of the cancer. CONCLUSION Expansion of vaginal RT for pregnant patients with uterine cervical cancer could be a practical option for pregnant patients with early invasive uterine cervical cancer.
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Affiliation(s)
- Mina Umemoto
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Shinichi Ishioka
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Yuko Mizugaki
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Yuya Fujibe
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Tasuku Mariya
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Akari Kawamata
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Masahito Mizuuchi
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Miyuki Morishita
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Tsuyoshi Baba
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo, Japan
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8
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Ishioka S. First case of twin pregnancy after vaginal radical trachelectomy in a Japanese woman. Surg Case Rep 2018. [DOI: 10.31487/j.scr.2018.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Twin pregnancy after radical trachelectomy (RT) for uterine cervical cancer involves an extremely high risk of preterm premature rupture of the membrane (pPROM) and the following occurrence of preterm birth. Herein we report the first case of twin pregnancy after vaginal RT in a Japanese woman. The patient was a 36-year-old nulliparous woman. She became pregnant with twins one year after vaginal RT with laparoscopic lymphadenectomy and the following treatment with the use of in vitro fertilization/embryo transfer. Her pregnancy course was favorable with vaginal disinfection, bed rest, and administration of progesterone, ritodrine, and an ulinastatin vaginal suppository. At 31 weeks + 4 days of pregnancy, a scheduled cesarean section was performed. One baby weighed 1000g, with Apgar scores of 7/8, and the other 1100g, with Apgar scores of 8/9. Her postpartum course was also favorable. The mother remains without evidence of recurrence of the cancer at the time of this report.
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Ishioka S, Kim M, Mizugaki Y, Kon S, Isoyama K, Mizuuchi M, Morishita M, Baba T, Sekiya T, Saito T. Transabdominal cerclage (TAC) for patients with ultra-short uterine cervix after uterine cervix surgery and its impact on pregnancy. J Obstet Gynaecol Res 2017; 44:61-66. [DOI: 10.1111/jog.13487] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/17/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Shinichi Ishioka
- Department of Obstetrics and Gynecology; Sapporo Medical University; Sapporo Japan
| | - Miseon Kim
- Department of Obstetrics and Gynecology; Sapporo Medical University; Sapporo Japan
| | - Yuko Mizugaki
- Department of Obstetrics and Gynecology; Sapporo Medical University; Sapporo Japan
| | - Saori Kon
- Department of Obstetrics and Gynecology; Sapporo Medical University; Sapporo Japan
| | - Kyoko Isoyama
- Department of Obstetrics and Gynecology; Sapporo Medical University; Sapporo Japan
| | - Masahito Mizuuchi
- Department of Obstetrics and Gynecology; Sapporo Medical University; Sapporo Japan
| | - Miyuki Morishita
- Department of Obstetrics and Gynecology; Sapporo Medical University; Sapporo Japan
| | - Tsuyoshi Baba
- Department of Obstetrics and Gynecology; Sapporo Medical University; Sapporo Japan
| | - Takao Sekiya
- Department of Obstetrics and Gynecology; Fujita Health University; Toyoake Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology; Sapporo Medical University; Sapporo Japan
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Tirlapur A, Willmott F, Lloyd P, Brockbank E, Jeyarajah A, Rao K. The management of pregnancy after trachelectomy for early cervical cancer. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/tog.12415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anushka Tirlapur
- Whipps Cross University Hospital, Barts Health NHS Trust; Whipps Cross Road London E11 1NR UK
| | - Fredric Willmott
- Whipps Cross University Hospital, Barts Health NHS Trust; Whipps Cross Road London E11 1NR UK
| | - Philippa Lloyd
- Royal London Hospital, Barts Health NHS Trust; Whitechapel Road London E1 1BB UK
| | - Elly Brockbank
- Royal London Hospital, Barts Health NHS Trust; Whitechapel Road London E1 1BB UK
| | - Arjun Jeyarajah
- Royal London Hospital, Barts Health NHS Trust; Whitechapel Road London E1 1BB UK
| | - Kalpana Rao
- Newham University Hospital, Barts Health NHS Trust; Glen Road London E13 8SL UK
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Bentivegna E, Maulard A, Pautier P, Chargari C, Gouy S, Morice P. Fertility results and pregnancy outcomes after conservative treatment of cervical cancer: a systematic review of the literature. Fertil Steril 2016; 106:1195-1211.e5. [DOI: 10.1016/j.fertnstert.2016.06.032] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/09/2016] [Accepted: 06/20/2016] [Indexed: 01/17/2023]
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12
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Lim YK, Lek SM, Yeo SH. Obstetric care after radical abdominal trachelectomy in a patient with stage IB1 cervical cancer: A case report and a review of medical literature. Gynecol Oncol Rep 2016; 17:86-8. [PMID: 27536720 PMCID: PMC4976664 DOI: 10.1016/j.gore.2016.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/27/2016] [Accepted: 07/28/2016] [Indexed: 01/21/2023] Open
Abstract
•A case on obstetric care after radical trachelectomy in early cervical cancer•Fertility sparing surgery provides favorable oncological and obstetrical outcomes.•Multidisciplinary teams are essential in managing this patient population.
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Affiliation(s)
- Yong Kuei Lim
- KK Women's and Children's Hospital, Department of Gynaecological Oncology, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Sze Min Lek
- Duke-National University of Singapore Medical School, 8 College Road, Singapore 169857, Singapore
| | - Seow Heong Yeo
- KK Women's and Children's Hospital, Department of Maternal-Foetal Medicine, 100 Bukit Timah Road, Singapore 229899, Singapore
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13
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Kim M, Ishioka S, Endo T, Baba T, Mizuuchi M, Takada S, Saito T. Possibility of less radical treatment for patients with early invasive uterine cervical cancer. J Obstet Gynaecol Res 2016; 42:876-82. [DOI: 10.1111/jog.12980] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/16/2015] [Accepted: 01/24/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Miseon Kim
- Department of Obstetrics and Gynecology; Sapporo Medical University, Hokkaido, Japan
| | - Shinichi Ishioka
- Department of Obstetrics and Gynecology; Sapporo Medical University, Hokkaido, Japan
| | - Toshiaki Endo
- Department of Obstetrics and Gynecology; Sapporo Medical University, Hokkaido, Japan
| | - Tsuyoshi Baba
- Department of Obstetrics and Gynecology; Sapporo Medical University, Hokkaido, Japan
| | - Masahito Mizuuchi
- Department of Obstetrics and Gynecology; Sapporo Medical University, Hokkaido, Japan
| | - Sakura Takada
- Department of Obstetrics and Gynecology; Sapporo Medical University, Hokkaido, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology; Sapporo Medical University, Hokkaido, Japan
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14
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Zapardiel I, Cruz M, Diestro MD, Requena A, Garcia-Velasco JA. Assisted reproductive techniques after fertility-sparing treatments in gynaecological cancers. Hum Reprod Update 2016; 22:281-305. [PMID: 26759231 DOI: 10.1093/humupd/dmv066] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/18/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The trend toward late childbearing has made fertility preservation a major issue for women who face gynecological cancer. New techniques in assisted reproductive medicine enable conception after primary treatment of these cancers. Here, we aimed to review the efficacy and safety of assisted reproductive techniques (ART) after fertility-preserving treatment of gynaecological cancers. METHODS We conducted a systematic literature review of both prospective and retrospective studies in the PubMed, EMBASE, CENTRAL and SciSearch databases. In the retrieved studies, we evaluated live births, clinical pregnancies, overall survival and disease-free survival. RESULTS We identified many prospective and retrospective studies on this topic, but no relevant randomized clinical trials. Fertility-sparing treatments with safe oncological outcomes are feasible in endometrial, cervical and ovarian cancer cases. After cancer treatment, ART seem safe and show variable obstetrical outcomes. CONCLUSIONS After fertility-preserving treatment for gynaecological cancers, ART can enable pregnancy to be achieved with apparent oncological safety. The success of such procedures should directly impact clinical practice and management of those patients who require fertility-sparing treatment.
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Affiliation(s)
- Ignacio Zapardiel
- Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | | | - Maria D Diestro
- Gynaecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
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Ishioka S, Endo T, Baba T, Akashi Y, Morishita M, Sugio A, Kanayama N, Saito T. Successful delivery after transabdominal cerclage of uterine cervix for cervical incompetence after radical trachelectomy. J Obstet Gynaecol Res 2015; 41:1295-9. [DOI: 10.1111/jog.12716] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/14/2015] [Accepted: 02/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Shinichi Ishioka
- Department of Obstetrics and Gynecology; Sapporo Medical University; Sapporo Hokkaido
| | - Toshiaki Endo
- Department of Obstetrics and Gynecology; Sapporo Medical University; Sapporo Hokkaido
| | - Tsuyoshi Baba
- Department of Obstetrics and Gynecology; Sapporo Medical University; Sapporo Hokkaido
| | - Yushi Akashi
- Department of Obstetrics and Gynecology; Sapporo Medical University; Sapporo Hokkaido
| | - Miyuki Morishita
- Department of Obstetrics and Gynecology; Sapporo Medical University; Sapporo Hokkaido
| | - Asuka Sugio
- Department of Obstetrics and Gynecology; Sapporo Medical University; Sapporo Hokkaido
| | - Naohiro Kanayama
- Department of Obstetrics and Gynecology; Hamamatsu University, School of Medicine, Hamamatsu; Shizuoka Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology; Sapporo Medical University; Sapporo Hokkaido
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Evolution in fertility-preserving options for early-stage cervical cancer: radical trachelectomy, simple trachelectomy, neoadjuvant chemotherapy. Int J Gynecol Cancer 2014; 23:982-9. [PMID: 23792600 DOI: 10.1097/igc.0b013e318295906b] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Fertility preservation is of paramount importance for young women diagnosed with early-stage cervical cancer. The radical trachelectomy procedure was developed to preserve uterine/reproductive function. The procedure has evolved significantly over the last 25 years. This review focuses on the various surgical techniques (vaginal, abdominal, laparoscopic, and robotic), highlighting advantages and disadvantages of each in relation to their respective obstetrical and oncologic outcomes. A trend toward even more conservative surgery (simple trachelectomy/large cone) has recently been advocated for patients with low-risk early lesions. Conversely, the option of neoadjuvant chemotherapy followed by fertility-preserving surgery for patients with larger-size lesions has also been proposed. Emerging data are presented.
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Fertility Conserving Management of Early Cervical Cancer: Our Experience of LLETZ and Pelvic Lymph Node Dissection. Int J Gynecol Cancer 2014; 24:118-23. [DOI: 10.1097/igc.0000000000000023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BackgroundPresently, for those diagnosed with early cervical cancer who wish to conserve their fertility, there is the option of radical trachelectomy. Although successful, this procedure is associated with significant obstetric morbidity. The recurrence risk of early cervical cancer is low and in tumors measuring less than 2 cm; if the lymphatics are negative, the likelihood of parametrial involvement is less than 1%. Therefore, pelvic lymph nodes are a surrogate marker of parametrial involvement and radical excision of the parametrium can be omitted if they are negative.ObjectiveThe aim of this study was to report our experience of the fertility conserving management of early cervical cancer with repeat large loop excision of the transformation zone and laparoscopic pelvic lymph node dissection.MethodsBetween 2004 and 2011, a retrospective review of cases of early cervical cancer who had fertility conserving management within Glasgow Royal Infirmary was done.ResultsForty-three patients underwent fertility conserving management of early cervical cancer. Forty were screen-detected cancers; 2 were stage IA1, 4 were stage IA2, and 37 were stage IB1. There were 2 central recurrences during the follow-up period. There have been 15 live children to 12 women and there are 4 ongoing pregnancies.ConclusionsTo our knowledge, this is the largest case series described and confirms the low morbidity and mortality of this procedure. However, even within our highly select group, there have been 2 cases of central recurrent disease. We, therefore, are urging caution in the global adoption of this technique and would welcome a multicenter multinational randomized controlled trial.
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Kim M, Ishioka SI, Endo T, Baba T, Akashi Y, Morishita M, Adachi H, Saito T. Importance of uterine cervical cerclage to maintain a successful pregnancy for patients who undergo vaginal radical trachelectomy. Int J Clin Oncol 2013; 19:906-11. [DOI: 10.1007/s10147-013-0631-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/14/2013] [Indexed: 11/30/2022]
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Difficulty in the management of pregnancy after vaginal radical trachelectomy. Int J Clin Oncol 2012; 18:1085-90. [DOI: 10.1007/s10147-012-0479-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
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Kim C, Abu-Rustum N, Chi D, Gardner G, Leitao M, Carter J, Barakat R, Sonoda Y. Reproductive outcomes of patients undergoing radical trachelectomy for early-stage cervical cancer. Gynecol Oncol 2012; 125:585-8. [DOI: 10.1016/j.ygyno.2012.03.014] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 03/02/2012] [Accepted: 03/08/2012] [Indexed: 11/25/2022]
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Ahn TG, Lee BR, Kim JK, Choi BC, Han SJ. Successful full term pregnancy and delivery after concurrent chemo-photodynamic therapy (CCPDT) for the uterine cervical cancer staged 1B1 and 1B2: Preserving fertility in young women. GYNECOLOGIC ONCOLOGY CASE REPORTS 2012; 2:54-7. [PMID: 24371616 DOI: 10.1016/j.gynor.2012.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 01/22/2012] [Indexed: 10/14/2022]
Abstract
► Photodynamic therapy can treat lesions with highly reactive single oxygen. ► CCPDT (Concurrent Chemo Photodynamic Therapy) is defined as PDT with chemotherapy. ► CCPDT can treat larger and deeper lesions than PDT due to PCI concept. ► Complete remission would be possible in uterine cervical cancer by CCPDT. ► Uterine cervix and corpus can be preserved in CCPDT.
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Affiliation(s)
- Tae-Gyu Ahn
- Department of Obstetrics and Gynecology, Chosun University, Gwang-ju, Republic of Korea
| | - Byoung-Rai Lee
- Department of Biochemistry and Molecular Biology, School of Medicine, Chosun University, Gwang-ju, Republic of Korea
| | - Jong-Ki Kim
- Department of Biomedical Engineering and Radiology, School of Medicine, The Catholic University of Taegu, Republic of Korea
| | - Bum-Chae Choi
- Department of Obstetrics and Gynecology, Creation and Love Women's Hospital, Gwang-ju, Republic of Korea
| | - Sei-Jun Han
- Department of Obstetrics and Gynecology, Chosun University, Gwang-ju, Republic of Korea
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Knight LJ, Acheson N, Kay TA, Renninson JN, Shepherd JH, Taylor MJO. Obstetric management following fertility-sparing radical vaginal trachelectomy for cervical cancer. J OBSTET GYNAECOL 2011; 30:784-9. [PMID: 21126113 DOI: 10.3109/01443615.2010.509826] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Radical vaginal trachelectomy now affords a fertility-sparing procedure for the treatment of early-stage cervical cancer in young women. Subsequent obstetric management within this group of women remains a challenge to the obstetrician, with risks of premature labour a continuing probability throughout pregnancy. Here we describe four cases of successful pregnancy following radical vaginal trachelectomy within our unit. The merits of early antenatal intervention, regular lower uterine segment length monitoring and use of daily progesterone pessaries are discussed, alongside the current supportive evidence. We conclude with a discussion of proposed recommendations for obstetric management of pregnancy in women post-radical vaginal trachelectomy.
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Affiliation(s)
- L J Knight
- Centre for Women's Health, Royal Devon and Exeter Hospital, Exeter, UK.
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Iwami N, Ishioka SI, Endo T, Baba T, Nagasawa K, Takahashi M, Sugio A, Takada S, Mariya T, Mizunuma M, Saito T. First case of vaginal radical trachelectomy in a pregnant Japanese woman. Int J Clin Oncol 2011; 16:737-40. [DOI: 10.1007/s10147-011-0209-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 02/13/2011] [Indexed: 11/24/2022]
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Plante M, Gregoire J, Renaud MC, Roy M. The vaginal radical trachelectomy: an update of a series of 125 cases and 106 pregnancies. Gynecol Oncol 2011; 121:290-7. [PMID: 21255824 DOI: 10.1016/j.ygyno.2010.12.345] [Citation(s) in RCA: 192] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 12/19/2010] [Accepted: 12/21/2010] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To review our first consecutive 125 vaginal radical trachelectomies (VRT) to assess the oncologic, fertility and obstetrical outcomes. METHODS Data from our prospective database was used to identify all VRT planned between October 1991 to March 2010 in patients with early-stage cervical cancer (stages IA, IB and IIA). Chi-square test, Fisher's exact test and Student t-test were used to compare baseline characteristics and Kaplan-Meier survival curves were constructed and compared with the use of the log-rank test. RESULTS During the study period, 140 VRT were planned and 125 were performed. The median age of the patients was 31 and 75% were nulliparous. The majority of the lesions were stage IA2 (21%) or IB1 (69%) and 41% were grade 1. In terms of histology, 56% were squamous and 37% were adenocarcinomas. Vascular space invasion was present in 29% of cases, and 88.5% of the lesions measured ≤2cm. The mean follow-up was 93months (range: 4-225months). There were 6 recurrences (4.8%) and 2 deaths (1.6%) following VRT. The actuarial 5-year recurrence-free survival was 95.8% [95% CI: 0.90-0.98], whereas it was 79% [95% CI: 0.49-0.93] in the group where the VRT was abandoned (p=0.001). Higher tumor grade, LVSI and size >2cm appeared to be predictive of the risk of abandoning VRT (p=0.001, p=0.025 and p=0.03 respectively). Tumor size >2cm was statistically significantly associated with a higher risk of recurrence (p=0.001). In terms of obstetrical outcome, 58 women conceived a total of 106 pregnancies. The first and second trimester miscarriage rates were 20% and 3% respectively, and 77 (73%) of the pregnancies reached the third trimester, of which 58 (75%) delivered at term. Overall, 15 (13.5%) patients experienced fertility problems, 40% of which were due to cervical factor. Twelve (80%) were able to conceive, the majority with assisted reproductive technologies. CONCLUSION VRT is an oncologically safe procedure in well-selected patients with early-stage disease. Lesion size >2cm appears to be associated with a higher risk of recurrence and a higher risk of abandoning the planned VRT. Fertility and obstetrical outcomes post VRT are excellent.
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Affiliation(s)
- Marie Plante
- Gynecologic Oncology Service, Centre Hospitalier Universitaire de Québec (CHUQ), L'Hôtel-Dieu de Québec, Laval University, Quebec City, Canada.
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Umemura K, Ishioka SI, Endo T, Baba T, Ezaka Y, Nagasawa K, Takahashi M, Mizuuchi M, Iwami N, Adachi H, Takeda N, Tamagawa M, Saito T. Changes of uterine blood flow after vaginal radical trachelectomy (VRT) in patients with early-stage uterine invasive cervical cancer. Int J Med Sci 2010; 7:260-6. [PMID: 20714436 PMCID: PMC2920571 DOI: 10.7150/ijms.7.260] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 08/04/2010] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Vaginal radical trachectomy (RT) ligates and cuts several arteries supplying the uterus. Changes of blood supply to the uterus in two patients who experienced pregnancy and delivery were studied by using 3-D CT scanning. Effects of changes of blood supply to the uterus on the pregnancy courses were also examined. METHODS Vascular distribution in the uterus was studied in two patients who received vaginal RT after delivery. Effects of changes of vascular distribution after vaginal RT were studied with respect to pregnancy courses and cervical functions. RESULTS New arterial vascularization from the ascending branches of uterine arteries or other arteries occurred, and these new vessels seemed to supply blood to the remaining cervix. Differences of fetal growth and histopathological changes in the placenta between the two patients could not be detected. CONCLUSION Ligation and cutting of several supplying arteries by RT induces new arterial vascularization and it does not seem to affect fetal growth and placental function.
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Affiliation(s)
- Kota Umemura
- Department of Obstetrics and Gynecology, Sapporo Medical University, Sapporo Hokkaido, Japan
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