Simple trachelectomy with pelvic lymphadenectomy as a viable treatment option in pregnant patients with stage IB1 (≥2 cm) cervical cancer: Bridging the gap to fetal viability

Objective: Cervical cancer is the most common gynecologic cancer in pregnancy. This study aims to evaluate simple trachelectomy and pelvic lymphadenectomy in patients with stage IB1 (≥2 cm) cervical cancer wishing to maintain their pregnancy. Methods: We included patients with stage IB1 (≥2 cm) cervical cancer who underwent simple trachelectomy and minimally invasive pelvic lymphadenectomy during pregnancy from January 2004 to August 2016. Data analysis included demographics, perioperative, obstetrics, and oncologic outcomes. Results: A total of 5 patients were included. Median age was 30 years (range; 26–38). Median gestational age (GA) at diagnosis was 12 weeks (range; 7–18) and at treatment intervention 16.5 weeks (range; 12–19). Histologic subtypes included: adenocarcinoma (3 patients) and squamous cell carcinoma (2 patients). Median tumor size by clinical exam was 27 mm (range; 20–40), grade 2 (range; 2–3) and depth of invasion 10 mm (range; 1.5–12). All patients underwent laparoscopic (1) or robotic (4) pelvic lymphadenectomy followed by vaginal simple trachelectomy. Median operative time was 193 min (range; 155–259), estimated blood loss 100 ml (range; 50–550) and length of stay 2 days (range; 1–3). There were no intraoperative or postoperative complications (<30 days). Median number of lymph nodes removed was 14 (range; 5–15). One patient had bilateral microscopic positive nodes. The median gestational age at delivery was 39 weeks (range; 28–40.6). After median follow-up of 75 months (range; 18–168), all patients are alive without disease. Conclusion: Simple trachelectomy with pelvic lymph node dissection may be a safe option in pregnant patients with stage IB1 (>2 cm) cervical cancer wishing to maintain their pregnancy.