Laparoscopic Radical Trachelectomy after Neoadjuvant Chemotherapy for Fertility Preservation in Early-Stage Bulky Cervical Cancer: A Case Report and Literature Review

Abstract

Management of early-stage cervical cancer (CC) in young women often faces challenges to preserve fertility, as well as to achieve an adequate oncological outcome. Although existing evidence supports a fertility-sparing treatment in the case of tumors <2 cm in diameter, the approach is less clear in bulky early-stage CC. In addition, the outcomes of radical trachelectomy performed by minimally invasive techniques are also highly debatable. Highlighting the high incidences of young women with early-stage CC, the lack of sufficient data raises considerable hindrances towards the proper counseling of this vulnerable patient group. In this report, a case of a young woman with bulky early-stage CC with a strong desire to preserve fertility is presented. A satisfactory oncological outcome was achieved after neoadjuvant chemotherapy followed by laparoscopic radical trachelectomy. Ongoing prospective trials are expected to provide stronger evidence on this topic.

Keywords: bulky early-stage cervical cancer; fertility-sparing treatment; laparoscopic radical trachelectomy; neoadjuvant chemotherapy.

Figure 1

Pelvic MRI performed at the initial evaluation of the patient, revealing cervical tumor 40 mm in the longest diameter.

Figure 2

Cervical cancer seen during colposcopic investigation before (A) and after (B) chemotherapy.

Figure 3

Colposcopy performed 2 months after radical trachelectomy.