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Hulshoff CC, Hofstede A, Inthout J, Scholten RR, Spaanderman MEA, Wollaars H, van Drongelen J. The effectiveness of transabdominal cerclage placement via laparoscopy or laparotomy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:100757. [PMID: 36179967 DOI: 10.1016/j.ajogmf.2022.100757] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Failure or technical impossibility to place a prophylactic transvaginal cerclage in women with cervical insufficiency justifies the need for an abdominal cerclage. In this systematic review and meta-analysis, we studied the obstetrical and surgical outcomes of laparoscopic and open laparotomy abdominal cerclage approaches performed before (interval) or during pregnancy. DATA SOURCES We performed a systematic literature search in PubMed, Embase, and the Cochrane Library for studies on laparoscopic and open laparotomy abdominal cerclage placement in February 2022. STUDY ELIGIBILITY CRITERIA All studies on laparoscopic or open laparotomy placement of an abdominal cerclage with at least 2 patients that reported on our primary outcomes were included. METHODS All included studies were assessed for quality and risk of bias with an adjusted Quality in Prognosis Study tool. Random effects meta-analyses were performed for the primary outcomes, namely fetal survival and gestational age at delivery. RESULTS Our search yielded 83 studies with a total of 3398 patients; 1869 of those underwent laparoscopic cerclage placement and 1529 underwent open laparotomy placements. No studies directly compared the 2 cerclage approaches. The survival (overall, 91.2%) and gestational age at delivery (overall, 36.6 weeks) were not statistically different between the approaches. For the procedure during pregnancy, the laparoscopic group showed significantly less blood loss >400 mL (0% vs 3%), a slightly lower procedure-related fetal loss (0% vs 1%), a shorter hospital stay but a longer operation duration than the open laparotomy group. For the interval cerclages, the laparoscopic group showed significantly fewer wound infections (0% vs 3%) and a shorter hospital stay than the open laparotomy group, but showed comparable offspring preterm birth and survival rates. CONCLUSION Based on indirect comparisons, the laparoscopic and open laparotomy abdominal cerclage placements at interval or during pregnancy produced similar outcomes in terms of survival and gestational age at delivery. There are some small differences in perioperative care, surgical complications, interventions, and complications during pregnancy. This implies that both methods of abdominal cerclage placement have high success rates and thus we cannot conclude that one of the methods is superior for the placement of an abdominal cerclage.
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Affiliation(s)
- Cecile C Hulshoff
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands (Drs Hulshoff, Hofstede, Scholten, Spaanderman, Wollaars, and Drongelen).
| | - Aniek Hofstede
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands (Drs Hulshoff, Hofstede, Scholten, Spaanderman, Wollaars, and Drongelen)
| | - Joanna Inthout
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Inthout)
| | - Ralph R Scholten
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands (Drs Hulshoff, Hofstede, Scholten, Spaanderman, Wollaars, and Drongelen)
| | - Marc E A Spaanderman
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands (Drs Hulshoff, Hofstede, Scholten, Spaanderman, Wollaars, and Drongelen)
| | - Hanna Wollaars
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands (Drs Hulshoff, Hofstede, Scholten, Spaanderman, Wollaars, and Drongelen)
| | - Joris van Drongelen
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands (Drs Hulshoff, Hofstede, Scholten, Spaanderman, Wollaars, and Drongelen)
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Baiocchi G, Tsunoda AT, Guitmann G, Vieira MA, Zanvettor PH, Silvestre JBCH, Santos MH, Sacramento RDMM, de Araujo EO, Lopes RH, Falcao D, Lopes A, Schmidt R, Lyra JS, Almeida HIB, Casteleins WA, Cintra GF, Zanini LAG, Reis RJ, Coelho EG, Fin FR, Rezende V, Pançan TDM, Vieira SC, Silva JS, de Andrade MR, Carneiro VCG, Foiato TF, Ritt GF, Ianaze GC, Moretti‐Marques R, Andrade CEMC, Maciel LF, Lira DL, Medeiros GM, Leite ALS, Cucolicchio GO, Tayeh MRA, Cruz RP, Guth GZ, Leal RMLV, Magno VA, Lopes FCO, Laporte GA, Pupo‐Nogueira A, Barros AV, da Cunha JR, Pessini SA, Braganca JF, Figueiredo HF, Loureiro CMB, Bocanegra RED, Affonso RJ, Fernandes PHDS, Ribeiro HSC, Batista TP, Oliveira AF, Ribeiro R. Brazilian Society of Surgical Oncology consensus on fertility‐sparing surgery for cervical cancer. J Surg Oncol 2022; 126:37-47. [DOI: 10.1002/jso.26899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/13/2022] [Indexed: 01/27/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Andre Lopes
- Sao Paulo State Institute of Cancer Sao Paulo Brazil
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Management of pregnancy after radical trachelectomy. Gynecol Oncol 2021; 162:220-225. [PMID: 33902946 DOI: 10.1016/j.ygyno.2021.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022]
Abstract
Radical trachelectomy (RT) is a surgery for early-stage cervical cancer treatment that preserves the childbearing ability, and its use has become increasingly common worldwide. Thus, the rate of conception in women who have undergone RT is increasing. However, pregnancy after RT is associated with a higher risk of several obstetric complications such as preterm delivery, preterm premature membrane rupture, and abnormal bleeding from varices at the site of uterovaginal anastomosis. Furthermore, since RT have a residual prophylactic cerclage, it is difficult to manage first- and second-trimester miscarriages. There is little previous data on the management of pregnancy after RT. In this review article, we summarize various management methods and experiences to provide a guide to clinicians for perinatal management after RT.
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Impact of additional risk factors on the incidence of preterm delivery among pregnant women diagnosed with short cervix. Taiwan J Obstet Gynecol 2020; 59:195-199. [PMID: 32127137 DOI: 10.1016/j.tjog.2020.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Additional risk factors for preterm delivery in pregnant women with cervical shortening are not fully understood; however, mid-trimester cervical shortening is accepted as a risk factor for preterm delivery. This study aimed to identify risk factors associated with subsequent preterm delivery among patients with short cervix detected after late mid-trimester. MATERIALS AND METHODS This was a retrospective study of medical data from a single perinatal tertiary facility. We identified 134 asymptomatic women with singleton pregnancies where cervical shortening (≤25 mm) was detected during routine universal screening at 22-33 weeks. Statistical analyses were conducted to identify causal relationships between the incidence of preterm delivery and known risk factors for preterm delivery. RESULTS Incidence of preterm delivery was 27.6% (37/134) and preterm premature rupture of membrane was preceded in 46.0% (17/37) of the women with preterm delivery. Using logistic regression analysis, we identified uterine contractions [aOR 4.25, 95% confidence intervals (CI):1.68-12.1] and increased C-reactive protein (CRP) and increased white blood cell (WBC) in blood test (CRP: aOR 3.45, 95% CI:1.50-9.71; WBC: aOR 1.28, 95% CI: 1.08-1.55) as risk factors which significantly increased the risk of preterm delivery among women diagnosed with short cervix. Preterm delivery occurred in 91% of women positive for both uterine contractions and CRP >0.5 mg/dl. CONCLUSIONS Uterine contraction and elevated CRP were additional risk factors for preterm delivery among women with short cervix. These results might be clinically useful to evaluate subsequent risk for preterm delivery in asymptomatic pregnant women presenting with short cervix in mid-pregnancy.
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Schaible B, Haught E, Vozar A, Riggs K, Calhoun B, Bush S, Bush S. Abdominal cerclage in a patient with a neocervix with planned cesarean hysterectomy at delivery. J Obstet Gynaecol Res 2020; 47:416-419. [PMID: 33084188 DOI: 10.1111/jog.14525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/26/2020] [Accepted: 09/20/2020] [Indexed: 11/27/2022]
Abstract
Pregnancies complicated by congenital uterine anomalies (CUA) with a neocervix present a variety of challenges for the obstetrician. Abdominal cerclage can be utilized to help prevent preterm delivery in a patient with a neocervix. A 14-year-old female presented with right adnexal pain and was found to have a complex uterine anomaly resembling a noncommunicating unicornuate uterus with a cervix embedded in the rudimentary horn. A neocervix was created during surgical removal of the rudimentary horn. The patient became pregnant at age 24, and a transabdominal cerclage served an important role in the prevention of preterm delivery. Although limited data exists regarding the outcomes for the use of abdominal cerclage after the creation of a neocervix, term delivery is possible with said intervention.
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Affiliation(s)
- Burk Schaible
- Department of Obstetrics and Gynecology, Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Erica Haught
- West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Amber Vozar
- West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Kassandra Riggs
- West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Byron Calhoun
- Department of Obstetrics and Gynecology, Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Stephen Bush
- Department of Obstetrics and Gynecology, Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Stephen Bush
- Department of Obstetrics and Gynecology, Charleston Area Medical Center, Charleston, West Virginia, USA
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Reed N, Balega J, Barwick T, Buckley L, Burton K, Eminowicz G, Forrest J, Ganesan R, Harrand R, Holland C, Howe T, Ind T, Iyer R, Kaushik S, Music R, Sadozye A, Shanbhag S, Siddiqui N, Syed S, Percival N, Whitham NL, Nordin A, Fotopoulou C. British Gynaecological Cancer Society (BGCS) cervical cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2020; 256:433-465. [PMID: 33143928 DOI: 10.1016/j.ejogrb.2020.08.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/05/2020] [Accepted: 08/21/2020] [Indexed: 01/20/2023]
Abstract
Cervix cancer in many countries is declining and screening programmes and immunisation will reduce the incidence in the next few decades. This guideline attempts to cover management of invasive disease reflecting diagnosis and imaging including new imaging and sentinel lymph node biopsies. Smaller volume disease is usually managed surgically whereas advanced disease is treated with (chemo)- radiation. It also includes discussion of fertility sparing procedures. Practices are changing frequently for all aspects of care usually in attempts to reduce complications and improve quality of life. The management of advanced disease is treated by chemotherapy and the use of newer agents is also discussed. Other sections discuss specialist situations such as cancer in pregnancy, rare cervical tumours, late effects and supportive measures and fertility preserving approaches.
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Affiliation(s)
- Nick Reed
- Beatson Oncology Centre, Glasgow, United Kingdom.
| | | | | | - Lynn Buckley
- Clinical Nurse Specialist, Hull University Teaching Hospitals NHS Trust, United Kingdom
| | | | | | | | | | | | | | | | - Thomas Ind
- Royal Marsden Hospital, London, United Kingdom
| | - Rema Iyer
- East Kent Hospitals University Foundation NHS Trust, United Kingdom
| | | | - Robert Music
- Jo's Cervical Cancer Trustt, London, United Kingdom
| | | | - Smruta Shanbhag
- University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom
| | | | - Sheeba Syed
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Natasha Lauren Whitham
- Lancashire Teaching Hospitals (Royal Preston Hospital, Fulwood, Lancashire), United Kingdom
| | - Andy Nordin
- East Kent Gynaecological Oncology Centre, East Kent Hospitals University Foundation Nhs Trust, Queen Elizabeth The Queen Mother Hospital, Margate, United Kingdom
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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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Shinkai S, Ishioka S, Mariya T, Fujibe Y, Kim M, Someya M, Saito T. Pregnancies after vaginal radical trachelectomy (RT) in patients with early invasive uterine cervical cancer: results from a single institute. BMC Pregnancy Childbirth 2020; 20:248. [PMID: 32334568 PMCID: PMC7183613 DOI: 10.1186/s12884-020-02949-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 04/14/2020] [Indexed: 01/27/2023] Open
Abstract
Background Radical tracheletomy (RT) with pelvic lymphadenectomy has become an option for young patients with early invasive uterine cervical cancer who desire to maintain their fertility. However, this operative method entails a high risk for the following pregnancy due to its radicality. Methods We have performed vaginal RT for 71 patients and have experienced 28 pregnancies in 21 patients. They were followed up carefully according to the follow-up methods we reported previously. Their pregnancy courses and prognoses after the pregnancy were retrospectively reviewed. Results All the vaginal RTs were performed safely without serious complications, including 6 patients who underwent the operation during pregnancy. The median time to be pregnant after RT was 29.5 months. 13 patients (46%) became pregnant without artificial insemination by husband or assisted reproductive technology. Cesarean section was performed for all of them. The median time of pregnancy was 34 weeks, and emergent cesarean section was performed for 7 pregnancies (25%). The median birth weight was 2156 g. Four patients had trouble with cervical cerclage, and they suffered from sudden premature preterm rupture of the membrane (pPROM) during the second trimester of pregnancy. We underwent transabdominal cerclage (TAC) for all of them and careful management for the prevention of uterine infection was performed. One patient had a recurrence of cancer during pregnancy. Conclusions Both the obstetrical prognosis and oncological prognosis after vaginal RT have become favorable for pregnant patients after vaginal RT.
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Affiliation(s)
- Shota Shinkai
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
| | - Shinichi Ishioka
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan.
| | - Tasuku Mariya
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
| | - Yuya Fujibe
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
| | - Miseon Kim
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
| | - Masayuki Someya
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
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Nezhat C, Roman RA, Rambhatla A, Nezhat F. Reproductive and oncologic outcomes after fertility-sparing surgery for early stage cervical cancer: a systematic review. Fertil Steril 2020; 113:685-703. [DOI: 10.1016/j.fertnstert.2020.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/25/2020] [Accepted: 02/03/2020] [Indexed: 12/21/2022]
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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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11
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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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12
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Costales A, Michener C, Escobar-Rodriguez PF. Radical Trachelectomy for Early Stage Cervical Cancer. Curr Treat Options Oncol 2018; 19:75. [PMID: 30450531 DOI: 10.1007/s11864-018-0591-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OPINION STATEMENT In patients with early-stage cervical cancer, radical hysterectomy and pelvic lymphadenectomy is the gold standard. However, this disease commonly affects women of childbearing age; thus an option to spare fertility is ideal. This option came to fruition in the early 90s when the Dargent procedure or radical trachelectomy was first reported. The procedure has subsequently been modified as technology has improved and now may be performed via minimally invasive techniques. Additionally, with the advent of the sentinel lymph node procedure, the morbidity in this usually young patient population has continued to improve. There is a multitude of data to show that oncologic outcomes, concerning recurrence and mortality, are comparable to radical hysterectomy, as well as obstetrical outcomes are favorable. Data to support its acceptance within the gynecologic oncology community has led to radical trachelectomy being implemented into governing body guidelines and should be offered to appropriate candidates with early-stage cervical cancer who wish to preserve fertility.
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Affiliation(s)
- Anthony Costales
- Gynecologic Oncology Division, Cleveland Clinic, Ob/Gyn and Women's Health Institute, 9500 Euclid Avenue, Desk A81, Cleveland, OH, 44195, USA.
| | - Chad Michener
- Gynecologic Oncology Division, Cleveland Clinic, Ob/Gyn and Women's Health Institute, 9500 Euclid Avenue, Desk A81, Cleveland, OH, 44195, USA
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Alvarez RM, Biliatis I, Rockall A, Papadakou E, Sohaib SA, deSouza NM, Butler J, Nobbenhuis M, Barton D, Shepherd JH, Ind T. MRI measurement of residual cervical length after radical trachelectomy for cervical cancer and the risk of adverse pregnancy outcomes: a blinded imaging analysis. BJOG 2018; 125:1726-1733. [PMID: 30099822 DOI: 10.1111/1471-0528.15429] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the association between the residual cervix measured on postoperative MRI after radical vaginal trachelectomy (RVT) and adverse obstetrical outcomes. DESIGN Observational study. SETTING Referral Cancer centre. POPULATION Women who conceived after RVT for cervical cancer at the Royal Marsden Hospital, London, between 1995 and 2015. METHODS 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. MAIN OUTCOME MEASURES Late miscarriage, premature delivery, premature rupture of membranes (PROM) and chorioamnionitis. RESULTS 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. CONCLUSIONS 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. TWEETABLE ABSTRACT The risk of prematurity after RVT can be predicted from measurements of residual cervical length on postoperative MRI scan.
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Affiliation(s)
- R M Alvarez
- Department of Gynaecological Oncology, The Royal Marsden Hospital NHS Trust, London, UK.,Department of Gynaecology and Gynaecological Oncology, Santa Cristina University Hospital, Madrid, Spain
| | - I Biliatis
- Department of Gynaecological Oncology, The Royal Marsden Hospital NHS Trust, London, UK
| | - A Rockall
- Department of Radiology, The Royal Marsden Hospital NHS Trust, London, UK
| | - E Papadakou
- Department of Gynaecological Oncology, The Royal Marsden Hospital NHS Trust, London, UK
| | - S A Sohaib
- Department of Radiology, The Royal Marsden Hospital NHS Trust, London, UK
| | - N M deSouza
- Department of Radiology, The Royal Marsden Hospital NHS Trust, London, UK
| | - J Butler
- Department of Gynaecological Oncology, The Royal Marsden Hospital NHS Trust, London, UK
| | - M Nobbenhuis
- Department of Gynaecological Oncology, The Royal Marsden Hospital NHS Trust, London, UK
| | - Djp Barton
- Department of Gynaecological Oncology, The Royal Marsden Hospital NHS Trust, London, UK.,St George's University of London, London, UK
| | - J H Shepherd
- Department of Gynaecological Oncology, The Royal Marsden Hospital NHS Trust, London, UK
| | - Tej Ind
- Department of Gynaecological Oncology, The Royal Marsden Hospital NHS Trust, London, UK.,St George's University of London, London, UK
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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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15
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Wong J, Tan GHC, Nadarajah R, Teo M. Novel management of a giant cervical myoma in a premenopausal patient. BMJ Case Rep 2017; 2017:bcr-2017-221408. [PMID: 28993358 DOI: 10.1136/bcr-2017-221408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cervical myomas are rare and account for <1% of uterine leiomyomas. Clinical complications include bulk-related symptoms of pelvic pain, abnormal bleeding and infertility. While hysterectomies may be readily performed for postmenopausal women; the management of women with cervical myomas of childbearing age remains a challenge.Traditionally described fertility-preserving procedures such as myomectomy, endometrial ablation or myolysis may only be applied to leiomyomas within the uterine corpus. Little is known about the surgical management of its cervical counterpart.Radical abdominal trachelectomy has been described as a potential fertility-preserving procedure in the management of women with early cervical cancer. As such, we present a case of a giant cervical myoma that was treated with an abdominal trachelectomy in an attempt to preserve fertility.
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Affiliation(s)
- Jolene Wong
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | | | | | - Melissa Teo
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore
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16
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Kasuga Y, Miyakoshi K, Nishio H, Akiba Y, Otani T, Fukutake M, Ikenoue S, Ochiai D, Matsumoto T, Tanaka K, Minegishi K, Kuji N, Roberts R, Aoki D, Tanaka M. Mid-trimester residual cervical length and the risk of preterm birth in pregnancies after abdominal radical trachelectomy: a retrospective analysis. BJOG 2017; 124:1729-1735. [PMID: 28418597 DOI: 10.1111/1471-0528.14688] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the association between mid-trimester residual cervical length (CL) and the risk of preterm birth in pregnancies after abdominal radical trachelectomy (RT). DESIGN Retrospective cohort study. SETTING University hospital. POPULATION A total of 33 deliveries after 22 weeks' gestation in 30 women who underwent abdominal RT including prophylactic cervical cerclage and perinatal care between January 2002 and May 2016. METHODS The association between mid-trimester residual CL (the distance between the cerclage and the external cervical os) and gestational age at delivery was investigated. Receiver-operating characteristics (ROC) curve analysis was performed to estimate the optimal cut-off values of the mid-trimester residual CL for the prediction of preterm birth. MAIN OUTCOME MEASURES Preterm birth before 34 weeks' gestation. RESULTS Mid-trimester residual CL showed a significant correlation with gestational age at delivery (r = 0.36, P < 0.05). There was a significant difference in residual CL between women who did and those who did not give birth before 34 weeks (P < 0.05). Mid-trimester residual CL < 13 mm was a good predictor of birth before 34 weeks, with a sensitivity of 67%, specificity of 75%, positive predictive value of 55% and negative predictive value of 86% (area under ROC curve, 0.75). CONCLUSIONS Mid-trimester residual CL is significantly correlated with gestational age at delivery. Residual CL assessment could be used to reassure physicians and women that there is only a small chance of preterm birth in pregnancies after abdominal RT. TWEETABLE ABSTRACT Mid-trimester residual cervical length is a good predictor of preterm birth after radical trachelectomy.
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Affiliation(s)
- Y Kasuga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - K Miyakoshi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - H Nishio
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Y Akiba
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - T Otani
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - M Fukutake
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - S Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - D Ochiai
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - T Matsumoto
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - K Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | | | - N Kuji
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan
| | - R Roberts
- Center for Clinical Research, Keio University School of Medicine, Tokyo, Japan
| | - D Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - M Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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17
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Saadi J, Minig L, Noll F, Saraniti G, Cárdenas-Rebollo JM, Perrotta M. Four Surgical Approaches to Cervical Excision During Laparoscopic Radical Trachelectomy for Early Cervical Cancer. J Minim Invasive Gynecol 2017; 24:869-875. [PMID: 28461178 DOI: 10.1016/j.jmig.2017.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/08/2017] [Accepted: 04/11/2017] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE To compare the clinical and oncological outcomes of four different approaches of cervical excision (CE) during radical trachelectomy (RT) for early cervical cancer. DESIGN A retrospective comparative observational study was performed at Gynecology Department of the Hospital Italiano de Buenos Aires in Buenos Aires, Argentine. The study was composed of all consecutive women who had undergone laparoscopic RT for early cervical cancer between May 2011 and July 2016. They were divided in four groups according with different surgical approaches to perform the CE during RT; which are also detailed. (Canadian Task Force Classification III). SETTING Tertiary care hospital. INTERVENTION CE during radical trachelectomy for early cervical cancer. MEASUREMENT AND MAIN RESULTS A total of 7, 6, 6 and 3 patients undergone Type A, B, C and D cervical excision during RT, respectively. No significant differences in terms of age, BMI, surgical time and length of hospital stay were found according with different types of CE. Patients in Type D had, however, a significantly higher EBL, p =.006. Similar histology characteristics in terms of histology type, tumor grade and size, as well as lymph node count were observed among groups. Only grade 1-2 postoperative complications were noted in 9 patients. One local recurrence after Type B CE was treated with radical surgery plus chemoradiaton; while other patient after Type A CE relapsed with peritoneal carcinomatosis managed with chemotherapy. CONCLUSION Different types of cervical excision that are here described should be used according to each case based on specific clinical factors.
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Affiliation(s)
- José Saadi
- Department of Gynecology, Gynecologic Oncology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Lucas Minig
- Gynecology Department, Valencian Institute of Oncology, Valencia, Spain
| | - Florencia Noll
- Department of Gynecology, Gynecologic Oncology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gabriel Saraniti
- Department of Gynecology, Gynecologic Oncology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Myriam Perrotta
- Department of Gynecology, Gynecologic Oncology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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18
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Sneider K, Christiansen OB, Sundtoft IB, Langhoff-Roos J. Recurrence rates after abdominal and vaginal cerclages in women with cervical insufficiency: a validated cohort study. Arch Gynecol Obstet 2017; 295:859-866. [PMID: 28233116 DOI: 10.1007/s00404-017-4315-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/01/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To estimate the incidence of cervical insufficiency and compare recurrence rates of second trimester miscarriage/delivery in second and third pregnancies after prophylactic vaginal cerclage, abdominal cerclage, or no cerclage. METHODS Retrospective chart review of a representative register-based sample of 621 women with a spontaneous second trimester miscarriage/delivery in the first pregnancy in Denmark (1997-2012). We used strict criteria for the diagnosis of cervical insufficiency. The outcome of subsequent pregnancies was described by treatment with prophylactic vaginal cerclage, abdominal cerclage, or no prophylactic cerclage. Women were followed until June 2015. RESULTS Of 621 women, 149 (24%) fulfilled the strict criteria of cervical insufficiency. Prophylactic treatment with abdominal cerclage (n = 20), vaginal cerclage (n = 59), and no prophylactic cerclage (n = 61) resulted in a second pregnancy ending before 28 weeks in 5, 30, and 72% (p < 0.001) and before 34 weeks in 10, 46, and 84% (p < 0.001), respectively. Take-home baby rate was 95% after abdominal cerclage, 73% after vaginal cerclage, and 33% after no cerclage. In a third pregnancy, abdominal cerclage (n = 47), vaginal cerclage (n = 38), and no cerclage (n = 8) resulted in pregnancy ending before 34 weeks of gestation in 2, 21, and 25%, respectively (p = 0.01). CONCLUSIONS Cervical insufficiency was diagnosed in 24% of women with an initial second trimester spontaneous miscarriage/delivery. In second and third pregnancies, recurrence rates were significantly lower after prophylactic vaginal or abdominal cerclage compared with no cerclage.
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Affiliation(s)
- Kirstine Sneider
- Department of Clinical Research, North Region Hospital, Hjørring, Denmark.
| | - Ole Bjarne Christiansen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.,The Fertility Clinic, University Hospital Copenhagen, Copenhagen, Denmark
| | - Iben Blaabjerg Sundtoft
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Jens Langhoff-Roos
- Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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19
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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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20
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Surgical and obstetrical outcomes after laparoscopic radical trachelectomy and pelvic lymphadenectomy for early cervical cancer. Obstet Gynecol Sci 2016; 59:373-8. [PMID: 27668200 PMCID: PMC5028644 DOI: 10.5468/ogs.2016.59.5.373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/11/2016] [Accepted: 05/13/2016] [Indexed: 01/25/2023] Open
Abstract
Objective The aim of this study was to evaluate the surgical and obstetrical outcomes of patients with early cervical cancer who underwent laparoscopic radical trachelectomy and pelvic lymphadenectomy. Methods We analyzed data from women who underwent laparoscopic radical trachelectomy and pelvic lymphadenectomy between July 2000 and October 2014. Results Of a total of 12 patients, 91.7% were FIGO (International Federation of Gynecology and Obstetrics) stages IA2 and IB1. Seven patients (58.3%) had squamous cell carcinoma. The median tumor size was 1.87 cm (range, focal to 4.6 cm) and two patients (16.7%) had a tumor lager than 2 cm. Lymphovascular space invasion in the tumor lesion was reported in six patients (50%). The following surgical complications were observed: neurogenic bladder (one patient), hemoperitoneum (one patient), and infection (one patient). A total of 33.3% had attempted to conceive, resulting in two pregnancies and two healthy babies. All pregnancies were achieved by in vitro fertilization and embryo transfer. Each woman underwent cesarean delivery because of premature pre-labor rupture of membranes at gestational weeks 27.3 and 33.3. After a median follow-up time of 4.4 years (range, 1 to 8 years), there were no recurrences or deaths. Conclusion Laparoscopic radical trachelectomy and pelvic lymphadenectomy should be offered as an alternative treatment for women with early stage cervical cancer who want to preserve their fertility.
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21
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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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22
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Incidence, risk factors and treatment of cervical stenosis after radical trachelectomy: A systematic review. Eur J Cancer 2015; 51:1751-9. [DOI: 10.1016/j.ejca.2015.05.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/08/2015] [Accepted: 05/14/2015] [Indexed: 11/23/2022]
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23
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Kim M, Ishioka S, Endo T, Baba T, Saito T. Obstetrical prognosis of patients with cervical intraepithelial neoplasia (CIN) after "coin-shaped" conization. Arch Gynecol Obstet 2015; 293:651-7. [PMID: 26305031 DOI: 10.1007/s00404-015-3860-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 08/18/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE Uterine cervical conization is related to adverse pregnancy outcomes in subsequent pregnancies. To deal with this problem, we started conservative coin-shaped conization for reproductive-aged patients with cervical intraepithelial neoplasia (CIN). Here we report both the obstetrical and oncological impacts of this operation in comparison with the standard cone-shaped resection. METHODS A total of 401 women 44 years old or younger were treated in our hospital by CO2 laser conization between 2003 and 2012, and subsequently 50 patients became pregnant. The patients were divided into two groups, a standard cone-shaped conization group (until 2008) and a shallow coin-shaped conization group (beginning in 2008). The pregnancy courses and oncological prognoses of these two groups were studied. RESULTS Cone height reduction of about 3 mm was done. However, there were no significant differences between the two groups with regard to the occurrence of oncological complications. In the standard conization group, 18 of the 25 patients delivered at term. In the coin-shaped conization group, 20 of the 25 patients delivered at term. There were no significant differences between the two groups with regard to the occurrence of various obstetrical complications. However, the reduction rate of cervical length over the pregnancy was smaller in the coin-shaped group and the number of patients with a short cervix length of 2 cm or less was smaller in the coin-shaped group. CONCLUSIONS Although conservative coin-shaped conization did not markedly improve the obstetrical prognosis, this operative procedure improved the reduction rate of uterine cervical length over the pregnancy without any increase in oncological complications.
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Affiliation(s)
- Miseon Kim
- Department of Obstetrics and Gynecology, Sapporo Medical University, Minami 1 jo, Nishi 16 chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Shinichi Ishioka
- Department of Obstetrics and Gynecology, Sapporo Medical University, Minami 1 jo, Nishi 16 chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Toshiaki Endo
- Department of Obstetrics and Gynecology, Sapporo Medical University, Minami 1 jo, Nishi 16 chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tsuyoshi Baba
- Department of Obstetrics and Gynecology, Sapporo Medical University, Minami 1 jo, Nishi 16 chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University, Minami 1 jo, Nishi 16 chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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24
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Hauerberg L, Høgdall C, Loft A, Ottosen C, Bjoern S, Mosgaard B, Nedergaard L, Lajer H. Vaginal Radical Trachelectomy for early stage cervical cancer. Results of the Danish National Single Center Strategy. Gynecol Oncol 2015; 138:304-10. [DOI: 10.1016/j.ygyno.2015.05.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
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25
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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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