The functional reconstruction of fertility-sparing radical abdominal trachelectomy for early stage cervical carcinoma

Abstract 

Objective

To study the feasibility and outcome of functional reconstruction during radical abdominal trachelectomy in the treatment of early stage cervical carcinoma.

Study design

Ten cervical cancer patients (FIGO stage IA2 or IB1 with tumours less than 2cm in diameter) who desired to preserve their fertility underwent abdominal radical trachelectomy with functional reconstruction, including preserving the ascending uterine artery, placing a stent to avoid intrauterine adhesions and using three pieces of mesh to prevent cervical incompetence and uterine prolapse.

Results

The mean age of the patients was 29 years (range 28–30). The average operative time was 261min (range 204–345), with a mean blood loss of 370ml (range 150–500). The mean time to remove the urinary catheter was 12 days (range 8–14) after surgery and the mean time to remove pelvic drainage was 4 days (range 2–8). During the follow-up (range 4–68 months), no recurrence was detected and a normal menstrual pattern resumed within 8 weeks after surgery. No abnormality was noted in the preserved ascending branches of the uterine arteries, and no intrauterine adhesion was found. One patient successfully conceived without reproductive assistance and another patient conceived with in vitro fertilization. There was no cervical incompetence or premature rupture of membrane in their pregnancies, and cesarean sections were done as in normal women at a gestation of 38⁺⁵ weeks and 34⁺³ weeks, respectively.

Conclusion

We conclude that the functional reconstruction is a good choice of fertility-sparing surgery for patients with early stage cervical carcinoma.

Keywords: Cervical cancer, Functional reconstruction, Mesh, Radical abdominal trachelectomy