Laparoscopic radical abdominal trachelectomy for the management of stage IB1 cervical cancer at 14 weeks' gestation: case report and review of the literature

Cervical Cancer Associated with Pregnancy: Current Challenges and Future Strategies

Cancer during pregnancy is defined as a tumor diagnosed in a pregnant woman or up to 1-year post-partum. While being a rare disease, cervical cancer is probably one of the most challenging medical conditions, with the dual stake of treating the cancer without compromising its chances for cure, while preserving the pregnancy and the health of the fetus and child. To date, guidelines for gynecological cancers are provided through international consensus meetings with expert panels, giving insights on both diagnosis, treatment, and obstetrical care. However, these expert guidelines do not discuss the various approaches than can be found within the literature, such as alternative staging modalities or innovative surgical approaches. Also, the obstetrical care of women diagnosed with cervical cancer during pregnancy requires specific considerations that are not provided within our current standard of care. This systematic review aims to fill the gap on current issues with regards to the management of cervical cancer during pregnancy and provide future directions within this evolving landscape.

The Double Life-Saving Approach of Abdominal Radical Trachelectomy during Pregnancy for Early-Stage Cervical Cancer-An Overview of the Literature and Our Institutional Experience

(1) Background: Cervical cancer is the most common type of cancer encountered during pregnancy, with a frequency of 0.8–1.5 cases per 10,000 births. It is a dire condition endangering patients’ lives and pregnancy outcomes, and jeopardizing their fertility. However, there is a lack of current evidence and consensus regarding a standard surgical technique for pregnant patients who suffer from this condition during pregnancy. The study aims to comprehensively update all published data, evaluating the obstetrical and oncological results of pregnant patients who underwent abdominal radical trachelectomy during early stages of cervical cancer. (2) Methods: A literature search on the Medline, PubMed, and Google Scholar databases was performed, including all articles in question up to July 2020. This study presents an overview of the literature and our institutional experience. (3) Results: A total of 25 cases of abdominal radical trachelectomy were performed during pregnancy for early cervical cancer, including the five cases managed by the authors. Of these, 81% (19 patients) gave birth to live newborns through elective C-section, and 19% (6 patients) experienced miscarriage shortly after the procedure. None of the 25 patients (100%) reported disease recurrence. (4) Conclusions: The results of the current study were satisfactory. However, abdominal radical trachelectomy does not represent the current standard of care for cervical cancer during pregnancy, but it could play an important role if more evidence on its effectiveness will be provided.

Abdominal Radical Trachelectomy for Early-Stage Cervical Cancer During Pregnancy: A Provocative Surgical Approach. Overview of the Literature and a Single-Institute Experience

OBJECTIVE

Treatment of pregnancy complication due to malignancy of the cervix constitutes a great clinical challenge between optimal maternal therapy and fetal viability. Radical trachelectomy in early-stage cervical cancer during pregnancy instead of radical hysterectomy presents an alternative approach that can offer a satisfactory outcome for the mother and fetus.

MATERIALS AND METHODS-RESULTS

A literature search of articles in English has been performed. Until now, 28 women with cervical cancer, including 2 who were managed and treated in our institute, who underwent a radical trachelectomy during pregnancy have been reported. We overviewed a total of 13 abdominal trachelectomies, 13 vaginal trachelectomies, and 2 laparoscopic trachelectomies.

CONCLUSIONS

Radical trachelectomy can widen the therapeutic approach of early-stage cervical cancer in pregnant women who wish to preserve their pregnancy, providing a possibility of receiving the proper treatment with no delay.

Abdominal radical trachelectomy during pregnancy: A systematic review of the literature

BACKGROUND

Lack of large trials or randomized studies characterize any type of treatment for cervical cancer during pregnancy experimental.

OBJECTIVE

To accumulate the existing evidence on abdominal radical trachelectomy (ART) during pregnancy.

SEARCH STRATEGY

Medline, Scopus and Google Scholar databases were thoroughly searched up to September 2018 for relevant studies in this field using the terms "Radical Trachelectomy", "Pregnancy", "Cervical cancer", "fertility sparring".

SELECTION CRITERIA

Observational studies and case reports which addressed cases of pregnant women who underwent ART for cervical cancer during pregnancy were included.

MAIN RESULTS

A total of ten studies which recruited 19 patients were finally included. At the time of ART, the gestational age of patients ranged from 7th to 22th weeks. Mean operative time of ART was 351.8 min while mean blood loss was 1,040.35 ml and 5 patients (50%) received blood transfusion. Fetal loss rate was 21.1% (n = 4) and from the completed deliveries 7 (46,66%) were preterm. Postoperative maternal related complication rate was 23.1% (n = 3/13). The mean follow-up was 16.89 months (SD 12.69), whereas all cases were free of disease without evidence of recurrence during their follow-up.

CONCLUSIONS

According to the existing evidence, ART may be a tolerable option for pregnant women with early-stage cervical cancer with acceptable oncological and obstetrical outcomes. Future multicenter randomized trials are of particular importance to elucidate the optimal treatment option.