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An International Series on Abdominal Radical Trachelectomy: 101 Patients and 28 Pregnancies
  1. Stephanie L. Wethington, MD*,
  2. David Cibula, MD, PhD,
  3. Linda R. Duska, MD,
  4. Leslie Garrett, MD§,
  5. Christine H. Kim, MD*,
  6. Dennis S. Chi, MD*,,
  7. Yukio Sonoda, MD*, and
  8. Nadeem R. Abu-Rustum, MD*,
  1. *Department of Surgery, Division of Gynecology, Memorial Sloan-Kettering Cancer Center, New York, NY;
  2. Gynecologic Oncology Center, Department of Obstetrics and Gynecology, General University Hospital, First Medical Faculty, Charles University, Prague, Czech Republic;
  3. Department of Obstetrics and Gynecology, Thornton Gynecologic Oncology Service, University of Virginia Health System, Charlottesville, VA;
  4. §Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; and
  5. Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY.
  1. Address correspondence and reprint requests to Nadeem R. Abu-Rustum, MD, Department of Surgery, Division of Gynecology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Box 225, New York, NY 10065, USA. E-mail: gynbreast{at}mskcc.org.

Abstract

Objectives Abdominal radical trachelectomy (ART) is a type C resection (uterine vessels ligated at origin from the hypogastric vessels). Questions arise as to whether fertility is maintained after ART, particularly when uterine vessels are sacrificed. We report an international series on ART to describe fertility and oncologic outcomes.

Methods Databases at 3 institutions were queried to identify patients planned for ART from 1999 to 2011. Clinical and demographic data were gathered.

Results One hundred one patients underwent ART. Mean age was 31 years (range, 19–43 years). Histologic classifications were adenocarcinoma (n = 54), squamous cell carcinoma (n = 40), adenosquamous carcinoma (n = 6), and clear cell carcinoma (n = 1). Twenty patients (20%) required conversion to hysterectomy (10 margins and 10 nodes). Eight patients underwent completion hysterectomy owing to the following: positive margins on final pathology (n = 3), patient’s choice (n = 4), or recurrence (n = 1). Postoperatively, 20 patients (20%) received adjuvant chemotherapy and/or radiation (4 final pathology margins and 16 nodes). Four patients (4%) had recurrence and lived 22 to 35 months after diagnosis. Of the 70 women who had neither hysterectomy nor adjuvant therapy, 38 (54%) attempted pregnancy and 28 (74%) achieved pregnancy. Thirty-one pregnancies resulted in 16 (52%) third trimester deliveries. Six patients are currently pregnant with outcomes pending.

Conclusions These data demonstrate that ART preserves fertility and maintains excellent oncologic outcomes. Most women (74%) attempting pregnancy after ART are able to achieve pregnancy and deliver in the third trimester (52%). Preservation of the uterine vasculature is not necessary for fertility; obstetrical outcomes are similar to those of the historical vaginal radical trachelectomy cohorts.

  • Trachelectomy
  • Cervical cancer
  • Fertility preservation

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Footnotes

  • The authors declare no conflicts of interest.

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