Abdominal Trachelectomy: Reproductive and Obstetric Outcomes
Abdominal Trachelectomy: Reproductive and Obstetric Outcomes
Study question: What are the reproductive and obstetric outcomes in patients undergoing radical abdominal trachelectomy (RAT) for early-stage cervical cancer?
Summary answer: When RAT was performed before a pregnancy achieved with fertility treatments, pregnancy rate of 36.2% was obtained and 71.4% of these women gave birth at ≥32 weeks of gestation.
What is known already: Reproductive and obstetric outcomes after radical vaginal trachelectomy (RVT) are well documented; however, these outcomes after RAT have not been well studied.
Study design, size, duration: This is a retrospective cohort study of patients at a single institution who underwent RAT and became pregnant. Reproductive and obstetric outcomes of 114 patients who had undergone RAT from September 2002 to December 2010 were investigated.
Participants/material, setting, methods: Women of reproductive age with early-stage cervical cancer who wished to preserve their fertility were documented.
Main results and the role of chance: Patients' median age was 33 years (25–40 years). A total of 31 pregnancies were achieved in 25 patients and 6 patients had 2 pregnancies. Eighteen of 25 patients (72.0%) had infertility problems; 17 patients conceived with IVF-embryo transfer and 1 patient with intrauterine insemination. The pregnancy rate among patients who wished to conceive was 36.2% (25/69). Among 31 pregnancies in 25 patients, 4 patients had first trimester miscarriage and 1 patient had second trimester miscarriage. Excluding the five patients who miscarried and the five ongoing pregnancies, all the 21 patients had deliveries by Cesarean section. Four patients had a preterm birth in the second trimester and 17 patients delivered in the third trimester. Of the 17 pregnancies that reached the third trimester, 2 (11.8%) were preterm births between 29 and 32 weeks, 11 (64.7%) were delivered between 32 and 37 weeks and 4 (23.5%) at ≥37 weeks of gestation.
Limitations, reasons for caution: Because of the retrospective data collection, not all pregnancies may have been recorded.
Wider implications of the findings: Prospective multicenter studies are needed to determine if the results shown in this retrospective cohort can be generalized to all patients with early-stage cervical cancer who wish to undergo the fertility-sparing RAT procedure.
Study funding/competing interest(S): There was no funding for this study. No conflicts of interest.
In recent years, cervical cancer has become the second most common malignancy in women and the number of patients diagnosed as having early-stage cervical cancer during their child-bearing years has been increasing (Jemal et al., 2011). With the recent trend of delaying child bearing, there has been an increased emphasis on fertility-sparing treatments. Since Daniel Dargent first published radical trachelectomy in 1994 (Dargent et al., 1994, 2000), the procedure, using the vaginal or abdominal approach, has been performed to provide oncological safety while preserving fertility (Abu-Rustum and Sonoda, 2007; Cibula et al., 2009; Gien and Covens, 2010; Rob et al., 2011). We have performed radical abdominal trachelectomy (RAT) in 114 patients between September 2002 and December 2010 (Nishio et al., 2009).
Previous reports indicated that radical trachelectomy results in similar oncologic outcomes as the conventional radical hysterectomy for early-stage cervical cancer (Lanowska et al., 2011; Xu et al., 2011). Many women have been reported to conceive spontaneously after radical vaginal trachelectomy (RVT). In a previous report from one institution, the 5-year cumulative pregnancy rate among women trying to conceive was 52.8% and assisted reproduction techniques (ART) were required in a minority of these patients (Plante et al., 2011). However, data for reproductive and obstetric outcomes have been particularly based on results of the RVT procedure and reports on obstetric outcome following RAT are limited (Kim et al., 2012).
Here, we evaluated the reproductive and obstetric outcomes of patients following RAT in a series of 31 pregnancies in 25 patients, which is the largest pregnant case series in RAT patients from a single institution to date.
Abstract and Introduction
Abstract
Study question: What are the reproductive and obstetric outcomes in patients undergoing radical abdominal trachelectomy (RAT) for early-stage cervical cancer?
Summary answer: When RAT was performed before a pregnancy achieved with fertility treatments, pregnancy rate of 36.2% was obtained and 71.4% of these women gave birth at ≥32 weeks of gestation.
What is known already: Reproductive and obstetric outcomes after radical vaginal trachelectomy (RVT) are well documented; however, these outcomes after RAT have not been well studied.
Study design, size, duration: This is a retrospective cohort study of patients at a single institution who underwent RAT and became pregnant. Reproductive and obstetric outcomes of 114 patients who had undergone RAT from September 2002 to December 2010 were investigated.
Participants/material, setting, methods: Women of reproductive age with early-stage cervical cancer who wished to preserve their fertility were documented.
Main results and the role of chance: Patients' median age was 33 years (25–40 years). A total of 31 pregnancies were achieved in 25 patients and 6 patients had 2 pregnancies. Eighteen of 25 patients (72.0%) had infertility problems; 17 patients conceived with IVF-embryo transfer and 1 patient with intrauterine insemination. The pregnancy rate among patients who wished to conceive was 36.2% (25/69). Among 31 pregnancies in 25 patients, 4 patients had first trimester miscarriage and 1 patient had second trimester miscarriage. Excluding the five patients who miscarried and the five ongoing pregnancies, all the 21 patients had deliveries by Cesarean section. Four patients had a preterm birth in the second trimester and 17 patients delivered in the third trimester. Of the 17 pregnancies that reached the third trimester, 2 (11.8%) were preterm births between 29 and 32 weeks, 11 (64.7%) were delivered between 32 and 37 weeks and 4 (23.5%) at ≥37 weeks of gestation.
Limitations, reasons for caution: Because of the retrospective data collection, not all pregnancies may have been recorded.
Wider implications of the findings: Prospective multicenter studies are needed to determine if the results shown in this retrospective cohort can be generalized to all patients with early-stage cervical cancer who wish to undergo the fertility-sparing RAT procedure.
Study funding/competing interest(S): There was no funding for this study. No conflicts of interest.
Introduction
In recent years, cervical cancer has become the second most common malignancy in women and the number of patients diagnosed as having early-stage cervical cancer during their child-bearing years has been increasing (Jemal et al., 2011). With the recent trend of delaying child bearing, there has been an increased emphasis on fertility-sparing treatments. Since Daniel Dargent first published radical trachelectomy in 1994 (Dargent et al., 1994, 2000), the procedure, using the vaginal or abdominal approach, has been performed to provide oncological safety while preserving fertility (Abu-Rustum and Sonoda, 2007; Cibula et al., 2009; Gien and Covens, 2010; Rob et al., 2011). We have performed radical abdominal trachelectomy (RAT) in 114 patients between September 2002 and December 2010 (Nishio et al., 2009).
Previous reports indicated that radical trachelectomy results in similar oncologic outcomes as the conventional radical hysterectomy for early-stage cervical cancer (Lanowska et al., 2011; Xu et al., 2011). Many women have been reported to conceive spontaneously after radical vaginal trachelectomy (RVT). In a previous report from one institution, the 5-year cumulative pregnancy rate among women trying to conceive was 52.8% and assisted reproduction techniques (ART) were required in a minority of these patients (Plante et al., 2011). However, data for reproductive and obstetric outcomes have been particularly based on results of the RVT procedure and reports on obstetric outcome following RAT are limited (Kim et al., 2012).
Here, we evaluated the reproductive and obstetric outcomes of patients following RAT in a series of 31 pregnancies in 25 patients, which is the largest pregnant case series in RAT patients from a single institution to date.
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