Abdominal radical trachelectomy during pregnancy: A systematic review of the literature

Abstract

Background: Lack of large trials or randomized studies characterize any type of treatment for cervical cancer during pregnancy experimental.

Objective: To accumulate the existing evidence on abdominal radical trachelectomy (ART) during pregnancy.

Search strategy: Medline, Scopus and Google Scholar databases were thoroughly searched up to September 2018 for relevant studies in this field using the terms "Radical Trachelectomy", "Pregnancy", "Cervical cancer", "fertility sparring".

Selection criteria: Observational studies and case reports which addressed cases of pregnant women who underwent ART for cervical cancer during pregnancy were included.

Main results: A total of ten studies which recruited 19 patients were finally included. At the time of ART, the gestational age of patients ranged from 7th to 22th weeks. Mean operative time of ART was 351.8 min while mean blood loss was 1,040.35 ml and 5 patients (50%) received blood transfusion. Fetal loss rate was 21.1% (n = 4) and from the completed deliveries 7 (46,66%) were preterm. Postoperative maternal related complication rate was 23.1% (n = 3/13). The mean follow-up was 16.89 months (SD 12.69), whereas all cases were free of disease without evidence of recurrence during their follow-up.

Conclusions: According to the existing evidence, ART may be a tolerable option for pregnant women with early-stage cervical cancer with acceptable oncological and obstetrical outcomes. Future multicenter randomized trials are of particular importance to elucidate the optimal treatment option.

Keywords: Cervical cancer; Fertility sparing; Pregnancy; Radical trachelectomy.