Radical abdominal trachelectomy for cervical malignancies: Surgical, oncological and fertility outcomes in 62 patients

ObjectiveTo report our experience of radical abdominal trachelectomy for patients with cervical malignancies.MethodsWe conducted a retrospective review of a prospectively maintained database of patients undergoing fertility-sparing radical abdominal trachelectomy for cervical malignancies at our institution from 04/2004 to 09/2010.ResultsSixty-four patients with cervical malignancies underwent laparotomy for planned radical abdominal trachelectomy. Two patients needed immediate completion of radical hysterectomy due to unfavorable intraoperative findings. Median age was 29.5 years (range, 11–41). Histology included 8 (12.9%) with adenocarcinoma, 50 (80.65%) with squamous carcinoma, 1 (1.61%) with adenosquamous carcinoma and 3 (4.84%) with botryoid sarcoma. Median number of nodes evaluated was 25 (range, 12–53); Ten (16.13%) patients with pathologic risk factors received adjuvant therapy. Fourteen of 36 IB1 cases had tumor size > 2 cm. No recurrences were observed at a median follow-up of 22.8 months. Five (8.06%) patients developed postoperative cervical stenosis — all occurred before we started to routinely install T-IUDs during the procedure. Thirty-eight patients completed the survey which aimed to understand what factors influenced these patients' reproductive outcomes. For various reasons, only 10 patients attempted to conceive and 2 of them succeeded. One of them delivered by cesarean section after 39 weeks and the other is currently pregnant.ConclusionsRadical abdominal trachelectomy seems to be a reasonable option for selected patients whose tumors are no larger than 4 cm when conducted by experienced gynecologic oncologists. The main perioperative complication is postoperative cervical stenosis, which could be effectively prevented by installation of a tailed T-IUD during the surgery. Social, familial and physical factors can largely influence the patients' reproductive outcomes. The issues of reproductive concerns and quality of life require further investigation.

Research Highlights
► ART could be an option for pediatric patients, for adult patients who have larger lesions, and for those with distorted anatomy from prior conizations.
► Placing a tailed T-IUD during the procedure could effectively prevent postoperative cervical stenosis.
► Less favorable obstetric outcomes after ART may be partially influenced by social, familial and physical factors.