Invasive cervical cancer during pregnancy: laparoscopic nodal evaluation before oncologic treatment delay

Abstract

Introduction: Cervical cancer is the most frequently encountered malignancy during pregnancy. Presence of nodal metastasis is the most important negative prognostic factor and its assessment represents a crucial parameter to decide if pregnancy can safely continue. We describe the results of 18 pregnant patients with cervical cancer who had their nodal status proved by means of laparoscopy.

Material and methods: Eighteen patients with cervical cancer who underwent laparoscopic pelvic lymphadenectomy during pregnancy at Charité-University Berlin and Friedrich-Schiller-University Jena between 1999 and 2010 were analyzed retrospectively.

Results: The mean age at diagnosis was 32 years (26-40) and gestational age between 6 and 23 weeks of pregnancy. The following FIGO stages of cervical cancer were treated: 1a1 for two women, 1a2 for one woman, 1b1 for thirteen women, 1b2 for one woman and 2a for one woman. The histological type was squamous carcinoma in nine cases and adenocarcinoma also in nine cases. All laparoscopic procedures were successfully completed; there was no surgery-associated mortality, morbidity, or conversion to laparotomy. Additionally, there were no complications for either mother or child related to the general anesthesia. The mean number of lymph nodes removed was 17 (6-46). Definitive cancer treatment was delayed for fourteen out of eighteen patients until delivery with an average delay interval of 17 (9-28) weeks. Lymph nodes were positive in 16% of the cases (3/18) and these patients received immediate cancer treatment. One patient decided to interrupt the gestation before delivery despite negative lymph nodes. Fourteen patients reached fetal maturity and gave birth to healthy babies by caesarean section. All patients are alive without evidence of disease at a mean follow-up time of 38 (5-128) months.

Conclusion: Laparoscopic pelvic lymphadenectomy during pregnancy is feasible and safe. Results suggest that in patients with cervical cancer complicated by pregnancy a planned delay of oncologic treatment can be a safe option after tumor metastasis to lymph nodes has been histopathologically ruled out.