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Case Reports
. 2024 Mar;31(3):1804-1805.
doi: 10.1245/s10434-023-14737-0. Epub 2023 Dec 10.

Laparoscopic-Assisted Vaginal Trachelectomy with Prophylactic Cerclage: A Safe Fertility-Sparing Treatment for Early Stage Cervical Cancer

Matteo Pavone  1   2   3 , Marta Goglia  4   5   6 , Giovanni Scambia  7 , Denis Querleu  4   7 , Cherif Akladios  8 , Lise Lecointre  4   8   9
Affiliations
Case Reports

Laparoscopic-Assisted Vaginal Trachelectomy with Prophylactic Cerclage: A Safe Fertility-Sparing Treatment for Early Stage Cervical Cancer

Matteo Pavone et al. Ann Surg Oncol. 2024 Mar.

Abstract

Background: In recent years fertility-sparing treatments are increasingly developing in patients with early stage cervical cancer.1,2 Among these, trachelectomy represents a milestone with a wide range of surgical approaches,3 evidence of oncological safety, and positive obstetric outcomes.4 PATIENTS AND METHODS: A 26-year-old patient underwent conization for CIN3 with a subsequent diagnosis of squamous cervical cancer stage FIGO IB1. After a negative laparoscopic bilateral pelvic nodes sampling and the radiologic evidence [positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI)] of a disease limited to the cervix, the patient was a candidate for trachelectomy according to her fertility-sparing desire.

Results: The first laparoscopic time is dedicated to the safe opening of the vesicouterine and rectovaginal spaces until the medial pararectal fossa. Ureters are found and bilateral ureterolysis performed under vision. Colpotomy is then vaginally achieved, and the cervix is closed in a vaginal cuff to avoid tumor spread. Careful dissection of the anterior and posterior septa is carried out until reunification with laparoscopic dissection. Bilateral parametrectomy is performed. Vaginal trachelectomy is finalized with a negative deep margin at the frozen section. In the second laparoscopic time a monofilament polypropylene sling cerclage is bilaterally positioned from posterior to anterior through the broad ligaments and fixed anteriorly on the uterine isthmus to prevent an eventual preterm delivery.

Conclusion: Laparoscopic-assisted vaginal trachelectomy is a feasible procedure combining the conservative advantages of the vaginal approach and the oncological safety of laparoscopic spaces dissection with possible good obstetric outcomes.

Keywords: Cervical cancer; Conservative management; Fertility preservation.

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References

    1. Fanfani F, Pedone Anchora L, Di Martino G, et al. Oncologic and obstetric outcomes after simple conization for fertility-sparing surgery in FIGO 2018 stage IB1 cervical cancer. Int J Gynecol Cancer. 2021;31(3):452–6. - DOI - PubMed
    1. Gabriele V, Lecointre L, Faller E, Akladios C. Type B laparoscopic radical trachelectomy with uterine artery preservation for stage IB1 cervical cancer. J Minim Invasive Gynecol. 2019;26(2):365. - DOI - PubMed
    1. Smith ES, Moon AS, O’Hanlon R, et al. Radical trachelectomy for the treatment of early-stage cervical cancer: a systematic review. Obstet Gynecol. 2020;136(3):533–42. - DOI - PubMed - PMC
    1. Morice P, Maulard A, Scherier S, et al. Oncologic results of fertility sparing surgery of cervical cancer: an updated systematic review. Gynecol Oncol. 2022;165(1):169–83. - DOI - PubMed

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