Search Results (21)

Fertility-sparing treatments (FSTs) have gained importance for young female cancer patients, especially those with early-stage cervical, ovarian, and endometrial cancers. However, concerns about the long-term safety of these procedures, particularly in more advanced cancers, persist. A literature review was conducted using databases such as PubMed, Scopus, and Web of Science. The search terms included “fertility preservation” and “gynaecological cancer”. Articles published between 2014 and 2024 were considered, with 39 articles cited in the paper. The inclusion criteria were female patients undergoing FST. Studies were excluded if prior treatments impacted fertility or if oncological outcomes were inadequately reported. Radical trachelectomy, laparoscopic fertility-sparing surgeries, and cryopreservation techniques, such as ovarian tissue vitrification and oocyte cryopreservation, offer viable options for preserving fertility in early-stage gynecological cancer patients. Radical trachelectomy and cryopreservation showed positive reproductive outcomes, with pregnancy rates of 30–50% in early-stage cases. GnRH analogs during chemotherapy also demonstrated benefits in maintaining fertility. Despite these advances, recurrence in more advanced stages (FIGO IA2 and beyond) remains a concern. Minimally invasive surgeries like robotic-assisted procedures demonstrated comparable fertility outcomes to traditional methods but with fewer complications. FST is a promising option for women with early-stage cancer, offering favorable reproductive and survival outcomes. However, further research is needed to confirm long-term oncological safety in advanced stages. Multidisciplinary approaches and individualized treatment planning are essential for optimizing outcomes. Full article

Cervical cancer is a major health issue worldwide, with approximately 660,000 new cases a year, particularly in women of reproductive age (47.4 ± 12.8 years at diagnosis). Current advances in screening and immunization have shifted cervical cancer diagnoses to earlier stages; as a result, fertility preservation is an essential component of building a treatment plan. Objectives: This systematic review aims to synthesize the existing techniques for fertility preservation with a focus on early-stage cervical cancer (cancer stage IA1-IB1). We will describe the different surgical and medical approaches for the treatment of cervical cancer, followed by an analysis of their oncologic safety and the associated reproductive risks and outcomes. Methods: A descriptive synthesis of the strategies for surgical management, including conization, radical trachelectomy, neoadjuvant chemotherapy (NACT), and radiotherapy, was completed. Fertility and successful pregnancy rely on patient selection, prognostic variables, and obstetric outcomes. The use of transposition of the ovaries and cryopreservation in the context of gonadotoxic treatment plans also requires investigation. Results: For patients meeting conservative eligibility criteria, conservative surgery for tumors up to 2 cm has been considered a safe oncological management strategy, although evidence remains limited. Pregnancy rate after conization ranged from 36 to 55% and 10 to 38% after radical trachelectomy. Ovarian function can be successfully preserved in >60% of laparoscopic transposition cases but resulted in a less than 15% chance of natural conception; the need for assistive reproductive techniques was often required. Conclusions: Fertility-preserving management of cervical cancer is safe and feasible in carefully selected patients, with oncologic outcomes comparable to more radical management. Continued innovation and randomized control trials in treatment paths and oncologic and fertility outcomes will benefit the field. Full article

Objectives: The aim of this study is to demonstrate the efficacy of the modified technique of radical organ-preserving surgery of invasive cervical cancer (CC) in patients of reproductive age. Methods: This study included 118 patients of reproductive age (34.9 ± 4.8 years) with a morphologically verified diagnosis of invasive CC (T1a-1bNxM0). All patients underwent organ-preserving surgery in the scope of radical trachelectomy. A shape memory mesh implant woven in the form of a stocking from superelastic nickelide titanium thread with subsequent fixation with separate sutures around the perimeter was used to form the uterine closure apparatus and to strengthen the utero-vaginal anastomosis. The mesh implant was made of superelastic thin nickelide titanium threads with a diameter of 60–40 microns on a metal knitting machine. All patients were prospectively followed up for a mean of 120 months. Results: No intraoperative or postoperative complications were revealed when using a shape memory implant made of titanium nickelide during radical trachelectomy to form a locking apparatus and strengthen the anastomosis zone. No cervical stenoses or mesh failures were noted in any case. The 5-year overall and recurrence-free survival rates were 100% and 98%, respectively. Two patients indicated recurrence; it occurred in 3 and 36 months. There were 42 spontaneous pregnancies, and 29 resulted in full-term delivery, whereas 2 and 11 ended in miscarriage and early abortion, respectively. Currently, 18 patients are at different stages of the use of assisted reproductive technologies. Conclusions: The shape memory implant made of titanium nickelide integrates well into the surrounding tissues and successfully imitates the effect of the cervix. The use of this sparing-surgery technique has shown reasonably good results in carrying the pregnancy to term and good reproductive outcomes. Full article

Background/Objectives: Obstetrical monitoring following radical trachelectomy (RT) for cervical cancer is marked by the lack of a standardized protocol, which may lead to delays in the intervention for cervical shortening. In light of the typical cervical remodeling process that occurs at the onset of labor, we hypothesized that the onset of premature cervical shortening in patients who have undergone radiotherapy commences at the internal ostium. Methods: We introduced the concepts of internal distance (distance between internal cervical ostium and cerclage thread) and the latent shortening of internal distance, which is characterized as a painless reduction in the internal distance, serving as an early marker of preterm contractions, thus enabling timely tocolytic intervention. Results: Three patients spontaneously conceived after RT. They were obstetrically followed-up after RT, using a combined approach of transvaginal ultrasound cervical markers and cardiotocography. Active tocolysis was used if internal distance shortening was observed. All patients delivered term healthy babies. Conclusions: The consistent ultrasound evaluation of both internal and external distances permits the proactive diagnosis of premature contractions and enables swift therapeutic measures. Full article

Background/Objectives: The primary aim of this systematic review was to evaluate fertility outcomes and the oncological safety of different surgical techniques of radical trachelectomy (RT). Methods: The systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search on PubMed, Embase, and Google Scholar was performed between 1 November 2023 and 31 March 2024 with no limits for the time of publication. Results: In total, 56 studies met the inclusion criteria: 22 for abdominal RT (1712 patients), 14 for endoscopic RT (445 patients), and 22 for vaginal RT (1158 patients). Data regarding certain steps of the procedure (uterine artery preservation, autonomous nerve-sparing, abdominal cerclage, types of sutures used for the cerclage, uterine dilatation during cerclage placement, prolongation of uterine catheterization, type of uterovaginal anastomosis, antibiotic prophylaxis, and suppression of menstruation) were extracted and analyzed with regard to the obstetrical and oncological outcomes. Endoscopic RT was associated with a significantly higher pregnancy rate and a lower rate of preterm deliveries. Uterine artery preservation was associated with a higher live birth rate. Nerve-sparing RT resulted in a higher pregnancy rate, but no differences in the attempt for pregnancy and live birth rates were observed. Conclusions: Taking into account the obstetrical outcomes, it seems that the preferred option for radical RT is an endoscopic procedure with preservation of the uterine artery and the pelvic autonomic nerves. However, the safety of the endoscopic approach should be evaluated in prospective trials. Full article

Background/Objectives: Fertility-sparing surgery (FSS) is a standard practice for managing early stage cervical cancer, yet significant variation exists in clinical approaches worldwide. Our objective was to ascertain current practices and preferences for cerclage use among expert centers globally regarding FSS in patients with early stage cervical cancer. Methods: We conducted a cross-sectional survey from May to July 2023 involving expert centers identified through their scientific contributions and participation in international workgroups and conferences.. The survey, comprising 27 questions, evaluated existing practices in FSS. Results: Out of the centers surveyed, 21 (36.2%) gynecologic oncologists responded. For tumors <2 cm, 86% of centers preferred radical trachelectomy, primarily via the vaginal approach, while 13.6% favored a simple trachelectomy. Three experts preferred simple trachelectomy (13.6%). For tumors >2 cm, 47.6% utilized neoadjuvant chemotherapy before trachelectomy. Others did not offer FSS or performed an abdominal radical trachelectomy. Over time, there has been a shift towards less radical surgeries for tumors <2 cm and increased use of neoadjuvant chemotherapy for larger tumors. Some abandoned the minimally invasive surgical approach. Nearly all experts (90.5%) placed a cerclage immediately following trachelectomy. Conclusions: The majority of experts opt for radical trachelectomy in early stage cervical cancer, with immediate cerclage placement being a common practice. However, considerable international variations highlight the urgent need for standardized guidelines and further research to optimize treatment strategies, balancing oncological safety with fertility outcomes. Full article

Septic abortion can lead to severe maternal morbidity and mortality. The management of septic abortion can be complicated by a history of radical trachelectomy and transabdominal cerclage placement. A 33-year-old G1P0 at 17 weeks and 6 days gestation presented in severe septic shock after being diagnosed 6 days prior with previable rupture of membranes at an outside hospital and managed expectantly. History was notable for cervical adenocarcinoma status post radical trachelectomy and transabdominal cerclage placement. Due to uterine occlusion from the cerclage, the patient underwent emergent uterine evacuation via an abdominal approach. The risks and benefits of expectant management of pre-viable rupture of membranes in patients with abdominal cerclage should be weighed very cautiously. Among women with abdominal cerclage for whom uterine evacuation is indicated, a transabdominal approach may be necessary. Full article

Radical trachelectomy allows for fertility preservation in patients with early cervical cancer not qualifying as “low-risk” as defined by ConCerv. This study reports on the 10-year surgical, oncological, and obstetrical experience of patients treated by radical abdominal trachelectomy at an Austrian tertiary care center. A retrospective chart analysis and telephone survey of all patients with FIGO stage IA2-IB2 (2018) cervical cancer treated by radical abdominal trachelectomy and pelvic lymphadenectomy between 2013 and 2022 were performed. Radical abdominal trachelectomy was attempted in 29 patients, of whom 3 patients underwent neoadjuvant chemotherapy. Three cases, including one after neoadjuvant therapy, required conversion to radical hysterectomy due to positive margins; four cases had positive lymph nodes following surgical staging and were referred to primary chemo-radiotherapy. Twenty-two (75.9%) successful abdominal radical trachelectomies preserving fertility were performed. According to final histopathology, 79.3% of tumors would not have met the “low-risk”-criteria. At a median follow-up of 64.5 (25.5–104.0) months, no recurrence was observed. Eight (36.4%) patients attempted to conceive, with a live birth rate of 62.5%. Radical abdominal trachelectomy appears oncologically safe in early-stage cervical cancers that do not fulfill the “low-risk”-criteria. Strict preoperative selection of patients who might qualify for more conservative surgical approaches is strongly recommended. Full article

Cervical cancer is frequently diagnosed in women during their reproductive years, and fertility preservation is an essential part of their cancer treatment. In highly selected patients with early stage, low-risk cervical cancer and a tumor size ≤ 2 cm, several treatment strategies can be offered for patients wishing to preserve fertility, including radical/simple trachelectomy or conization with pelvic lymph node assessment. Trachelectomy can be performed through a vaginal, abdominal, or minimally invasive approach and has been shown to have an equivalent oncologic outcome compared to radical hysterectomy. All surgical approaches for radical trachelectomy seem to have excellent survival with comparable oncologic outcomes. Nevertheless, patients undergoing vaginal trachelectomy have better obstetric outcomes compared to the other routes. In patients with larger tumors (2–4 cm), neoadjuvant chemotherapy followed by fertility-sparing surgery is an alternative option. Several chemotherapy regimens have been used for this indication, with a pathologic complete response rate of 17–73%. For locally advanced diseases that require radical hysterectomy or primary chemoradiation, fertility preservation can be performed using oocyte, embryo, or ovarian tissue cryopreservation, as well as ovarian transposition. For these patients, future pregnancy is possible through surrogacy. In addition to fertility preservation, ovarian transposition, where the ovaries are repositioned outside of the radiation field, is performed to maintain ovarian hormonal function and prevent premature ovarian failure. In summary, fertility-preservation treatment strategies for patients with early stage cervical cancer are continuously evolving, and less radical surgeries are becoming more acceptable. Additional and ongoing evidence is helping determine the impact of conservative procedures on oncologic and obstetric outcomes in these patients. Full article

This study aimed to introduce FD-2, a newly developed anticervical stenosis device for patients with cervical cancer undergoing radical trachelectomy. Using ethylene-vinyl acetate copolymers, we developed FD-2 to prevent uterine cervical stenosis after radical trachelectomy. The tensile test and extractables and leachables testing were performed to evaluate FD-2’s safety as a medical device. FD-2 was indwelled in three patients with cervical cancer during radical trachelectomy and its utility was preliminarily evaluated. FD-2 consists of a head (fish-born-like structure), neck (connecting bridges), and body (tubular structure); the head is identical to FD-1, an intrauterine contraceptive device. FD-2 passed the tensile test and extractables and leachables testing. The average time required for the application or removal of FD-2 in cervical cancer patients was less than 10 s. The median duration of FD-2 indwelling was 8 weeks. No complications, including abdominal pain, pelvic infections, or hemorrhages, associated with FD-2 indwelling were reported. At the 3–12-month follow-up after the radical trachelectomy, no patients developed cervical stenosis or experienced dysmenorrhea. In conclusion, we developed FD-2, a novel device that can be used for preventing cervical stenosis after radical trachelectomy for uterine cervical cancer. Full article

Vaginal cuff dehiscence (VCD) is a rare but serious condition associated with high morbidity, especially in the presence of an evisceration. It usually occurs as a complication of hysterectomy, but has also been reported after other pelvic surgeries. In this article, we will present two cases of vaginal cuff dehiscence with evisceration in post-menopausal patients. Both cases occurred post-operatively, the first after a laparoscopic radical hysterectomy and the other after a trachelectomy performed by robotic-assisted laparoscopy (with a prior history of subtotal hysterectomy). Both cases were treated surgically, the first by a combined laparoscopic and vaginal approach, and the second case only by laparoscopic approach. The main risk and protective factors are discussed in a narrative literature review which summarizes the available evidence on this rare condition, discussed by type of study designs and thus evidence level. A laparoscopic vaginal cuff closure is the most protective factor in preventing VCD, compared to a vaginal closure. Clinicians should be aware of this condition and of its risk factors and precipitating events in order to identify high-risk patients. Knowledge of these allows prompt recognition, which is crucial for adequate management, for which multiple approaches have been described. Full article

Management of early-stage cervical cancer (CC) in young women often faces challenges to preserve fertility, as well as to achieve an adequate oncological outcome. Although existing evidence supports a fertility-sparing treatment in the case of tumors <2 cm in diameter, the approach is less clear in bulky early-stage CC. In addition, the outcomes of radical trachelectomy performed by minimally invasive techniques are also highly debatable. Highlighting the high incidences of young women with early-stage CC, the lack of sufficient data raises considerable hindrances towards the proper counseling of this vulnerable patient group. In this report, a case of a young woman with bulky early-stage CC with a strong desire to preserve fertility is presented. A satisfactory oncological outcome was achieved after neoadjuvant chemotherapy followed by laparoscopic radical trachelectomy. Ongoing prospective trials are expected to provide stronger evidence on this topic. Full article

Objective: Fertility-sparing surgery (FSS) is the treatment of choice for patients with early cervical cancer (ECC) and fertility desire, but survival rates compared to radical hysterectomy (RH) have been scarcely reported. The aim of this study was to analyse the oncological outcomes of FSS compared to a balanced group of standard RH. Methods: A retrospective multicentre study of ECC patients who underwent FSS or RH was carried out in 12 tertiary hospitals in Spain between January 2005 and January 2019. The experimental group included patients who underwent a simple and radical trachelectomy, and the control group included patients who underwent RH. Optimal 1:1 propensity score (PS) matching analysis was performed to balance the series. Results: The study included 222 patients with ECC; 111 (50%) were treated with FSS, and 111 (50%) were treated with RH. After PS matching, a total of 38 patients in the FSS group and 38 patients in the RH group were analysed. In both groups, the overall survival (HR 2.5; CI 0.89, 7.41) and recurrence rates (28.9% in the FSS group vs. 13.2% in RH group) were similar. The rate of disease-free survival at 5 years was 68.99% in the FSS group and 88.01% in the RH group (difference of −19.02 percentage points; 95% CI −32.08 to −5.96 for noninferiority). In the univariate analysis, only tumour size reached statistical significance. Conclusion: FSS offers excellent disease-free and overall survival in women with ECC with fertility desire and is not inferior compared to RH. Full article

Nowadays, the optimal management of patients with cervical cancers measuring 2–4 cm desiring to maintain fertility is still uncertain. In this systematic review, we assessed the reliability of neoadjuvant chemotherapy (NACT) prior to fertility-sparing (FS) surgery in International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IB2 cervical cancer, in terms of pathologic response, oncological and obstetric outcomes. The review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data, using MEDLINE and PubMed, were searched for from 1 January 2005 up to 1 December 2020. We identified 20 articles and 114 women with IB2 disease, possible candidates for NACT prior to FS surgery. However, uterine conservation was achieved only in 76.7% of them. Patients reached optimal pathological response to NACT in 60.9% of cases and a TIP (cisplatin, ifosfamide and paclitaxel) regime was related to the best response. Suboptimal response to NACT appeared to be an independent negative prognostic factor. Up to 9.2% of patients recurred with a median 7.4-months DFS, and 4.6% of patients died of disease. Fifty percent of women tried to conceive after treatment and NACT prior to conization appeared to be the most promising alternative to upfront radical trachelectomy in terms of obstetric outcomes. In conclusion, NACT prior to FS surgery is an option, but the literature about this issue is still weak and FS should be carefully discussed with patients. Full article

This study aimed to assess the accuracy of predicting pelvic lymph node status using sentinel lymph node (SLN) biopsy with indocyanine green (ICG) and to examine the outcomes of SLN biopsy-guided abdominal radical trachelectomy (ART). Patients with stage IA2–IB2 cervical cancer from January 2009 to January 2021 were included. ICG was injected before ART and SLNs were identified, excised, and assessed intraoperatively using fast-frozen sections. Systemic pelvic lymphadenectomy was subsequently performed. The SLN detection rate, sensitivity, and false-negative rate were determined. Thirty patients desiring fertility preservation were enrolled, of whom 26 successfully completed ART and four underwent radical hysterectomies because of metastatic primary SLNs. Bilateral SLNs were identified in all patients. The sensitivity, false-negative rate, and negative predictive value were 100%, 7.7%, and 92.3%, respectively. Three (12%) patients were lost to follow-up: two relapsed and one died of tumor progression. Of the nine patients who tried to conceive after surgery, four achieved pregnancy and three delivered healthy live infants. In women with early-stage cervical cancer who desired to conserve fertility, SLN mapping with ICG had a very high detection rate, sensitivity, and low false-negative rate. SLN biopsy-guided ART is a feasible and accurate method for assessing pelvic node status. Full article