Management of Pregnancy after Radical Trachelectomy: Case Reports and Systematic Review of the Literature

 

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ABSTRACT

This article reviews the existing literature on pregnancy outcomes following radical trachelectomy for low-stage cervical carcinoma and describes the guidelines in our institution for obstetrical management after managing two pregnancies following radical trachelectomy. We performed a literature search in PUBMED, MEDLINE, and EMBASE for the keywords “radical trachelectomy,” “pregnancy,” or “fertility” from 1994 to the present. All observational studies were included, and duplicate cases were excluded from our review. In addition to our cases, 14 studies were reviewed and included. Selection criteria included case reports or series detailing pregnancy outcomes including gestational age at delivery. Data regarding pregnancy outcomes were tabulated from the reports with focus on additional procedures such as vaginal occlusion and delivery outcomes. Where data were unclear, the authors personally contacted the authors of previously published manuscripts for further data. Our results revealed that 40% of women conceived following radical trachelectomy. Of them they had a preterm delivery rate of 25%, and 42% culminated in delivery of a live born infant at term. The use of the vaginal occlusion procedure did not appear to prolong gestation when compared with those women who did not have the procedure, but the majority of successful pregnancy outcomes have occurred with a cerclage in place. In conclusion, successful pregnancy outcome is possible after radical trachelectomy for cervical cancer, with two thirds of pregnancies resulting in a live birth, including those of both cases reported. There is a higher frequency of adverse perinatal outcomes in these patients, however, and careful interdisciplinary planning and counseling prior to undertaking the trachelectomy is recommended.

REFERENCES

• 1 Dargent D, Brun J L, Roy M et al.. Pregnancies following radical trachelectomy for invasive cervical cancer [abstract].  Gynecol Oncol. 1994;  52 105
  PubMedGoogle Scholar
• 2 Rodriguez M, Guimares O, Rose P G. Radical abdominal trachelectomy and pelvic lymphadenectomy with uterine conservation and subsequent pregnancy in the treatment of early invasive cervical cancer.  Am J Obstet Gynecol. 2001;  185 370-374
  CrossrefPubMedGoogle Scholar
• 3 Ungar L, Palfalvi L, Hogg R et al.. Abdominal radical trachelectomy: a fertility-preserving option for women with early cervical cancer.  BJOG. 2005;  112 366-369
  PubMedGoogle Scholar
• 4 Shepherd J H, Spencer C, Herod J, Ind T EJ. Radical vaginal trachelectomy as a fertility-sparing procedure in women with early-stage cervical cancer-cumulative pregnancy rate in a series of 123 women.  BJOG. 2006;  113 719-724
  Google Scholar
• 5 Roy M, Plante M. Pregnancies after radical vaginal trachelectomy for early-stage cervical cancer.  Am J Obstet Gynecol. 1998;  179 1491-1496
  PubMedGoogle Scholar
• 6 Plante M, Renaud M C, Hoskins I A, Roy M. Vaginal radical trachelectomy: A valuable fertility-preserving option in the management of early-stage cervical cancer. A series of 50 pregnancies and review of the literature.  Gynecol Oncol. 2005;  98 3-10
  CrossrefPubMedGoogle Scholar
• 7 Covens A, Shaw P, Murphy J et al.. Is radical trachelectomy a safe alternative to radical hysterectomy for patients with stage IA-B carcinoma of the cervix?.  Cancer. 1999;  86 2273-2279
  CrossrefPubMedGoogle Scholar
• 8 Bernardini M, Barrett J, Seaward G, Covens A. Pregnancy outcomes in patients after radical trachelectomy.  Am J Obstet Gynecol. 2003;  189 1378-1382
  CrossrefPubMedGoogle Scholar
• 9 Dargent D, Martin X, Sacchetoni A, Mathevet P. Laparoscopic vaginal radical trachelectomy. A treatment to preserve the fertility of cervical carcinoma patients.  Cancer. 2000;  88 1877-1882
  CrossrefPubMedGoogle Scholar
• 10 Mathevet P, Laszlo de Kaszon E, Dargent D. Fertility preservation in early cervical cancer.  Gynecol Obstet Fertil. 2003;  31 706-712
  CrossrefPubMedGoogle Scholar
• 11 Shepherd J H, Mould T, Oram D H. Radical trachelectomy in early stage carcinoma of the cervix: outcome as judged by recurrence and fertility rates.  BJOG. 2001;  108 882-885
  PubMedGoogle Scholar
• 12 Palfalvi L, Ungar L, Boyle D C, Del Priore G, Smith J R. Announcement of a health baby boy born following abdominal radical trachelectomy.  Int J Gynecol Cancer. 2003;  13 250
  CrossrefPubMedGoogle Scholar
• 13 Kay T A, Rennison J N, Shepherd J H, Taylor M JO. Successful pregnancy following radical trachelectomy and in vitro fertilisation with ovum donation.  BJOG. 2006;  113 965-966
  PubMedGoogle Scholar
• 14 Ungar L, Smith J R, Palfalvi L, Del Priore G. Abdominal radical trachelectomy during pregnancy to preserve pregnancy and fertility.  Obstet Gynecol. 2006;  108 811-814
  PubMedGoogle Scholar
• 15 Roman L D. Pregnancy after radical vaginal trachelectomy: Maybe not such a risky undertaking after all.  Gynecol Oncol. 2005;  98 1-2
  CrossrefPubMedGoogle Scholar
• 16 Hertel H, Kohler C, Grund D et al.. Radical vaginal trachelectomy (RVT) combined with laparoscopic pelvic lymphadenectomy: Prospective multicenter study of 100 patients with early cervical cancer.  Gynecol Oncol. 2006;  103 506-511
  Google Scholar
• 17 Tewari K S, DiSaia P J. Ovulatory failure, fertility preservation, and reproductive strategies in the setting of gynecologic and non-gynecologic malignancies.  Eur J Gynaecol Oncol. 2006;  27 449-461
  PubMedGoogle Scholar
• 18 Saling E. Early total occlusion of os uteri to prevent habitual abortion and premature deliveries.  Z Geburtshilfe Perinatol. 1981;  185 259-261
  PubMedGoogle Scholar
• 19 Plante M, Roy M. New approaches in the surgical management of early stage cervical cancer.  Curr Opin Obstet Gynecol. 2001;  13 41-46
  CrossrefPubMedGoogle Scholar
• 20 Burnett A F, Roman L D, O'Meara A T, Morrow C P. Radical vaginal trachelectomy and pelvic lymphadenectomy for preservation of fertility in early cervical carcinoma.  Gynecol Oncol. 2003;  88 419-423
  CrossrefPubMedGoogle Scholar
• 21 Davis G, Berghella V, Talucci M, Wapner R J. Patients with a prior failed transvaginal cerclage: a comparison of obstetric outcomes with either transabdominal or transvaginal cerclage.  Am J Obstet Gynecol. 2000;  183 836-839
  CrossrefPubMedGoogle Scholar
• 22 Burnett A F. Radical trachelectomy with laparoscopic lymphadenectomy: review of oncologic and obstetric outcomes.  Curr Opin Obstet Gynecol. 2006;  18 8-13
  PubMedGoogle Scholar
• 23 Boss E A, vanGolde R JT, Beerendonk C CM, Massuger L FAG. Pregnancy after radical trachelectomy: A real option?.  Gynecol Oncol. 2005;  99 S152-S156
  CrossrefPubMedGoogle Scholar
• 24 Alexopoulos E, Efkarpidis S, Fay T N, Williamson K M. Pregnancy following radical trachelectomy and pelvic lymphadenectomy for stage I cervical adenocarcinoma.  Acta Obstet Gynecol Scand. 2002;  189 791-792
  PubMedGoogle Scholar
• 25 Burnham A, Venkitaraman U, Street P. Successful pregnancy following trachelectomy and laparoscopic pelvic lymphadenectomy for cervical cancer.  Gynaecol Endosc. 2000;  9 73-74
  CrossrefPubMedGoogle Scholar
• 26 Ishioka S, Endo T, Hayashi T et al.. Successful delivery after vaginal radical trachelectomy for invasive uterine cervical cancer.  Int J Clin Oncol. 2006;  11 146-149
  CrossrefPubMedGoogle Scholar
• 27 Lavie O, Peer G, Sagi S, Ben Arie A, Auslender R. The management of early missed abortion after radical trachelectomy-a case report and a review of the literature.  Int J Gynecol Cancer. 2006;  16 1688-1690
  CrossrefPubMedGoogle Scholar
• 28 Martin X JB, Goltier F, Romestaing P, Raudrant D. First case of pregnancy after radical trachelectomy and pelvic irradiation.  Gynecol Oncol. 1999;  74 286-287
  CrossrefPubMedGoogle Scholar
• 29 Petignat P, Stan C, Megevand E, Dargent D. Pregnancy after trachelectomy: a high-risk condition of preterm delivery. Report of a case and review of the literature.  Gynecol Oncol. 2004;  94 575-577
  CrossrefPubMedGoogle Scholar
• 30 Schlaerth J B, Spirtos N M, Schlaerth A C. Radical trachelectomy and pelvic lymphadenectomy with uterine preservation in the treatment of cervical cancer.  Am J Obstet Gynecol. 2003;  188 29-34
  CrossrefPubMedGoogle Scholar
• 31 Personal communication with Dr. Krishnansu Tewari.  Department of Gynecologic Oncology, University of California, Irvine Medical Center.
  Google Scholar
• 32 Health Canada .Canadian Perinatal Health Report, 2003. Ottawa; Minister of Public Works and Government Services Canada 2003
  Google Scholar
• 33 Kolomainen D F, Herod J J, Holland N, Shepherd J H. Actinomyces on a Papanicolaou smear following radical trachelectomy.  BJOG. 2003;  110 1036-1037
  PubMedGoogle Scholar
• 34 Koliopoulos G. Conservative surgical methods for FIGO stage IA2 squamous cervical carcinoma and their role in preserving women's fertility.  Gynecol Oncol. 2004;  93 469-473
  CrossrefPubMedGoogle Scholar
• 35 Meis P J, Klebanoff M, Thom E et al.. Network. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate.  N Engl J Med. 2003;  348 2379-2385
  CrossrefPubMedGoogle Scholar

Deborah A WingM.D. 

Associate Professor and Director, Maternal-Fetal Medicine

101 The City Drive, Suite 800, Building 56, Orange, CA 92868; reprints not available from the author