Abdominal radical trachelectomy as fertility‑sparing management for early stages of cervical cancer: Our experience in 18 cases

Kiss,Szilard Leo; Fandi,Anas; Cozlea,Alexandra Lavinia; Gheorghe,Mihai; Stanca,Mihai; Bacalbașa,Nicolae; Moldovan,Andreea Anamaria; Căpîlna,Mihai Emil

doi:10.3892/etm.2021.10106

Abdominal radical trachelectomy as fertility‑sparing management for early stages of cervical cancer: Our experience in 18 cases

Authors:
- Szilard Leo Kiss
- Anas Fandi
- Alexandra Lavinia Cozlea
- Mihai Gheorghe
- Mihai Stanca
- Nicolae Bacalbașa
- Andreea Anamaria Moldovan
- Mihai Emil Căpîlna
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Affiliations: First Obstetrics and Gynecology Clinic, ‘George Emil Palade’ University of Medicine, Pharmacy, Science and Technology, 540136 Târgu Mures, Romania, Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020022 Bucharest, Romania, Department of Infectious Diseases, Brașov County Emergency Hospital, 500326 Brașov, Romania
Published online on: April 23, 2021 https://doi.org/10.3892/etm.2021.10106
Article Number: 674
Copyright: © Kiss et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The aim of this study was to present our experience of 18 cases of abdominal radical trachelectomy (ART), including 5 performed during pregnancy, analyzing patient selection, surgical complications, and oncological and obstetrical outcomes. This reproductive study included all early stage cervical cancer patients referred for ART at the 1st Obstetrics and Gynecology Clinic of the Emergency Clinical County Hospital Targu Mures, between 2010 and 2020. A total of 19 women were considered for ART, and only 1 case required conversion to radical hysterectomy. The patient mean age was 31 years (range 24‑38 years), and 66.67% of the patients were nulliparous. Six women (33.33%) had stage IA2, 4 (22.22%) had stage IB1, 5 (27.78%) had stage IB2, and 4 (22.22%) had stage IB3 disease. One intraoperative complication occurred in this series, which consisted in both right ureteral and bladder injuries. Early postoperative complications were represented by urinary bladder dysfunction (33.33%), symptomatic pelvic lymphocele (11.1%), peritonitis (5.5%), and wound infection (5.5%). Late postoperative complications included cervical stenosis (5.5%), amenorrhea (11.1%), and pelvic abscess (5.5%). Four out of the 18 patients were operated on during pregnancy between 14 and 20 weeks; 2 of them gave birth at term, 2 of them aborted shortly after the surgery. Two vaginal recurrences were recorded; both were managed by hysterectomy, partial colpectomy and adjuvant chemoradiotherapy. At this moment, all patients are alive with no evidence of disease and 3 of them managed to conceive. In conclusion, ART should be recommended as a fertility‑preserving procedure for women in their reproductive age. In selected cases, ART can be performed during pregnancy with encouraging results.

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