Pregnancy Outcomes after Abdominal Radical Trachelectomy for Early-Stage Cervical Cancer: A 13-Year Experience in a Single Tertiary-Care Center

Yoshifumi Kasuga, Hiroshi Nishio, Kei Miyakoshi, Suguru Sato, Juri Sugiyama, Tadashi Matsumoto, Kyoko Tanaka, Daigo Ochiai, Kazuhiro Minegishi, Toshio Hamatani, Takashi Iwata, Toru Morisada, Masaru Nakamura, Takuma Fujii, Naoaki Kuji, Daisuke Aoki, Mamoru Tanaka

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Abstract

Objective To investigate pregnancy outcomes in women after abdominal radical trachelectomy (RT) for early-stage cervical cancer. Methods The patients' background, fertility, and pregnancy outcomes were reviewed in a total of 61 pregnancies in 48 of 172 women who underwent abdominal RT at Keio University Hospital between September 2002 and December 2013. Results There were 5 women with stage IA1, 2 with stage IA2, and 41 with stage IB1. Histological types were as follows: squamous cell carcinoma (n = 36), adenocarcinoma (n = 10), and adenosquamous cell carcinoma (n = 2). The pregnancy rate of women attempting to conceive after abdominal RT was 44% (48/109). The mean ± SD duration from abdominal RT to conception was 3.1 ± 1.9 years. Of 61 pregnancies, 42 pregnancies were achieved by fertility treatment (in vitro fertilization-embryo transfer, 39; intrauterine insemination, 3). After excluding one pregnancy without detailed clinical information, there were 42 live births (5 in 22-27 weeks, 11 in 28-33weeks, 20 in 34-36 weeks, and 6 in 37-38 weeks), 13 miscarriages, and 5 ongoing pregnancies. While there were 10 first trimester miscarriages, 3 pregnancies ended in the second trimester owing to chorioamnionitis. The mean gestational age at birth was 33 weeks of pregnancy. Thirty-seven neonates were appropriate-for-date, and one was small-for-date. Six pregnancies exhibited massive bleeding from the residual cervix in the late pregnancy. Preterm birth less than 34 weeks of pregnancy was related to premature rupture of the membrane (P <0.05). Chorioamnionitis was evident in 9 of 11 pregnancies with preterm premature rupture of the membrane followed by birth at less than 34 weeks of pregnancy. No parturients exhibited lochiometra and endometritis postpartum. Conclusions Abdominal RT provided favorable pregnancy outcomes, and fertility treatment could be advantageous to conception. Massive bleeding from the residual cervix as well as ascending infection might be characteristic features during pregnancy after abdominal RT.

Original languageEnglish
Pages (from-to)163-168
Number of pages6
JournalInternational Journal of Gynecological Cancer
Volume26
Issue number1
DOIs
Publication statusPublished - 2016 Jan 1

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Pregnancy Outcome
Tertiary Care Centers
Uterine Cervical Neoplasms
Pregnancy
Fertility
Chorioamnionitis
Parturition
Spontaneous Abortion
Cervix Uteri
Trachelectomy
Abdominal Pregnancy
Adenosquamous Carcinoma
Hemorrhage
Endometritis
Insemination
Embryo Transfer
Premature Birth
Live Birth
Second Pregnancy Trimester
Pregnancy Rate

Keywords

  • Abdominal radical trachelectomy
  • Early-stage cervical cancer
  • Fertility treatment
  • Massive vaginal bleeding
  • Preterm rupture of the membrane

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Oncology

Cite this

@article{ac15c3d53ec04ad6a5dc8bc067448810,
title = "Pregnancy Outcomes after Abdominal Radical Trachelectomy for Early-Stage Cervical Cancer: A 13-Year Experience in a Single Tertiary-Care Center",
abstract = "Objective To investigate pregnancy outcomes in women after abdominal radical trachelectomy (RT) for early-stage cervical cancer. Methods The patients' background, fertility, and pregnancy outcomes were reviewed in a total of 61 pregnancies in 48 of 172 women who underwent abdominal RT at Keio University Hospital between September 2002 and December 2013. Results There were 5 women with stage IA1, 2 with stage IA2, and 41 with stage IB1. Histological types were as follows: squamous cell carcinoma (n = 36), adenocarcinoma (n = 10), and adenosquamous cell carcinoma (n = 2). The pregnancy rate of women attempting to conceive after abdominal RT was 44{\%} (48/109). The mean ± SD duration from abdominal RT to conception was 3.1 ± 1.9 years. Of 61 pregnancies, 42 pregnancies were achieved by fertility treatment (in vitro fertilization-embryo transfer, 39; intrauterine insemination, 3). After excluding one pregnancy without detailed clinical information, there were 42 live births (5 in 22-27 weeks, 11 in 28-33weeks, 20 in 34-36 weeks, and 6 in 37-38 weeks), 13 miscarriages, and 5 ongoing pregnancies. While there were 10 first trimester miscarriages, 3 pregnancies ended in the second trimester owing to chorioamnionitis. The mean gestational age at birth was 33 weeks of pregnancy. Thirty-seven neonates were appropriate-for-date, and one was small-for-date. Six pregnancies exhibited massive bleeding from the residual cervix in the late pregnancy. Preterm birth less than 34 weeks of pregnancy was related to premature rupture of the membrane (P <0.05). Chorioamnionitis was evident in 9 of 11 pregnancies with preterm premature rupture of the membrane followed by birth at less than 34 weeks of pregnancy. No parturients exhibited lochiometra and endometritis postpartum. Conclusions Abdominal RT provided favorable pregnancy outcomes, and fertility treatment could be advantageous to conception. Massive bleeding from the residual cervix as well as ascending infection might be characteristic features during pregnancy after abdominal RT.",
keywords = "Abdominal radical trachelectomy, Early-stage cervical cancer, Fertility treatment, Massive vaginal bleeding, Preterm rupture of the membrane",
author = "Yoshifumi Kasuga and Hiroshi Nishio and Kei Miyakoshi and Suguru Sato and Juri Sugiyama and Tadashi Matsumoto and Kyoko Tanaka and Daigo Ochiai and Kazuhiro Minegishi and Toshio Hamatani and Takashi Iwata and Toru Morisada and Masaru Nakamura and Takuma Fujii and Naoaki Kuji and Daisuke Aoki and Mamoru Tanaka",
year = "2016",
month = "1",
day = "1",
doi = "10.1097/IGC.0000000000000571",
language = "English",
volume = "26",
pages = "163--168",
journal = "International Journal of Gynecological Cancer",
issn = "1048-891X",
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TY - JOUR

T1 - Pregnancy Outcomes after Abdominal Radical Trachelectomy for Early-Stage Cervical Cancer

T2 - A 13-Year Experience in a Single Tertiary-Care Center

AU - Kasuga, Yoshifumi

AU - Nishio, Hiroshi

AU - Miyakoshi, Kei

AU - Sato, Suguru

AU - Sugiyama, Juri

AU - Matsumoto, Tadashi

AU - Tanaka, Kyoko

AU - Ochiai, Daigo

AU - Minegishi, Kazuhiro

AU - Hamatani, Toshio

AU - Iwata, Takashi

AU - Morisada, Toru

AU - Nakamura, Masaru

AU - Fujii, Takuma

AU - Kuji, Naoaki

AU - Aoki, Daisuke

AU - Tanaka, Mamoru

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Objective To investigate pregnancy outcomes in women after abdominal radical trachelectomy (RT) for early-stage cervical cancer. Methods The patients' background, fertility, and pregnancy outcomes were reviewed in a total of 61 pregnancies in 48 of 172 women who underwent abdominal RT at Keio University Hospital between September 2002 and December 2013. Results There were 5 women with stage IA1, 2 with stage IA2, and 41 with stage IB1. Histological types were as follows: squamous cell carcinoma (n = 36), adenocarcinoma (n = 10), and adenosquamous cell carcinoma (n = 2). The pregnancy rate of women attempting to conceive after abdominal RT was 44% (48/109). The mean ± SD duration from abdominal RT to conception was 3.1 ± 1.9 years. Of 61 pregnancies, 42 pregnancies were achieved by fertility treatment (in vitro fertilization-embryo transfer, 39; intrauterine insemination, 3). After excluding one pregnancy without detailed clinical information, there were 42 live births (5 in 22-27 weeks, 11 in 28-33weeks, 20 in 34-36 weeks, and 6 in 37-38 weeks), 13 miscarriages, and 5 ongoing pregnancies. While there were 10 first trimester miscarriages, 3 pregnancies ended in the second trimester owing to chorioamnionitis. The mean gestational age at birth was 33 weeks of pregnancy. Thirty-seven neonates were appropriate-for-date, and one was small-for-date. Six pregnancies exhibited massive bleeding from the residual cervix in the late pregnancy. Preterm birth less than 34 weeks of pregnancy was related to premature rupture of the membrane (P <0.05). Chorioamnionitis was evident in 9 of 11 pregnancies with preterm premature rupture of the membrane followed by birth at less than 34 weeks of pregnancy. No parturients exhibited lochiometra and endometritis postpartum. Conclusions Abdominal RT provided favorable pregnancy outcomes, and fertility treatment could be advantageous to conception. Massive bleeding from the residual cervix as well as ascending infection might be characteristic features during pregnancy after abdominal RT.

AB - Objective To investigate pregnancy outcomes in women after abdominal radical trachelectomy (RT) for early-stage cervical cancer. Methods The patients' background, fertility, and pregnancy outcomes were reviewed in a total of 61 pregnancies in 48 of 172 women who underwent abdominal RT at Keio University Hospital between September 2002 and December 2013. Results There were 5 women with stage IA1, 2 with stage IA2, and 41 with stage IB1. Histological types were as follows: squamous cell carcinoma (n = 36), adenocarcinoma (n = 10), and adenosquamous cell carcinoma (n = 2). The pregnancy rate of women attempting to conceive after abdominal RT was 44% (48/109). The mean ± SD duration from abdominal RT to conception was 3.1 ± 1.9 years. Of 61 pregnancies, 42 pregnancies were achieved by fertility treatment (in vitro fertilization-embryo transfer, 39; intrauterine insemination, 3). After excluding one pregnancy without detailed clinical information, there were 42 live births (5 in 22-27 weeks, 11 in 28-33weeks, 20 in 34-36 weeks, and 6 in 37-38 weeks), 13 miscarriages, and 5 ongoing pregnancies. While there were 10 first trimester miscarriages, 3 pregnancies ended in the second trimester owing to chorioamnionitis. The mean gestational age at birth was 33 weeks of pregnancy. Thirty-seven neonates were appropriate-for-date, and one was small-for-date. Six pregnancies exhibited massive bleeding from the residual cervix in the late pregnancy. Preterm birth less than 34 weeks of pregnancy was related to premature rupture of the membrane (P <0.05). Chorioamnionitis was evident in 9 of 11 pregnancies with preterm premature rupture of the membrane followed by birth at less than 34 weeks of pregnancy. No parturients exhibited lochiometra and endometritis postpartum. Conclusions Abdominal RT provided favorable pregnancy outcomes, and fertility treatment could be advantageous to conception. Massive bleeding from the residual cervix as well as ascending infection might be characteristic features during pregnancy after abdominal RT.

KW - Abdominal radical trachelectomy

KW - Early-stage cervical cancer

KW - Fertility treatment

KW - Massive vaginal bleeding

KW - Preterm rupture of the membrane

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