Trachelectomy during pregnancy: what has experience taught us?

Area of Science:

• Gynecologic Oncology
• Reproductive Medicine
• Surgical Oncology

Background:

• Treating early-stage cervical cancer during pregnancy presents unique challenges for preserving fertility and ensuring fetal well-being.
• Radical hysterectomy is the standard treatment for cervical cancer, but it results in the loss of fertility.
• Vaginal radical trachelectomy (VRT) is a fertility-sparing surgical option for early-stage cervical cancer, but its application during pregnancy is less established.

Observation:

• A 22-year-old pregnant patient at 17 weeks' gestation was diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IB1 squamous cell cervical carcinoma.
• The patient successfully underwent a vaginal radical trachelectomy (VRT) at 19 weeks and 5 days gestation.
• The patient delivered a healthy male infant via cesarean section at 36 weeks' gestation, weighing 2795 g.

Findings:

• The VRT procedure was technically successful in removing the cervical tumor while preserving the uterus.
• Post-operative follow-up at 13 months showed no evidence of recurrent cervical cancer in the patient.
• The successful delivery of a healthy infant demonstrates the feasibility of VRT during pregnancy.

Implications:

• Vaginal radical trachelectomy (VRT) is a viable and potentially life-saving fertility-sparing treatment option for select pregnant patients with early-stage cervical cancer.
• This case highlights the importance of multidisciplinary care involving gynecologic oncologists, obstetricians, and neonatologists for optimal patient outcomes.
• Further research and case studies are warranted to establish VRT as a standard treatment protocol in pregnant patients with cervical cancer.