Surgical Techniques for Radical Trachelectomy

Abstract

Background/Objectives: The primary aim of this systematic review was to evaluate fertility outcomes and the oncological safety of different surgical techniques of radical trachelectomy (RT). Methods: The systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search on PubMed, Embase, and Google Scholar was performed between 1 November 2023 and 31 March 2024 with no limits for the time of publication. Results: In total, 56 studies met the inclusion criteria: 22 for abdominal RT (1712 patients), 14 for endoscopic RT (445 patients), and 22 for vaginal RT (1158 patients). Data regarding certain steps of the procedure (uterine artery preservation, autonomous nerve-sparing, abdominal cerclage, types of sutures used for the cerclage, uterine dilatation during cerclage placement, prolongation of uterine catheterization, type of uterovaginal anastomosis, antibiotic prophylaxis, and suppression of menstruation) were extracted and analyzed with regard to the obstetrical and oncological outcomes. Endoscopic RT was associated with a significantly higher pregnancy rate and a lower rate of preterm deliveries. Uterine artery preservation was associated with a higher live birth rate. Nerve-sparing RT resulted in a higher pregnancy rate, but no differences in the attempt for pregnancy and live birth rates were observed. Conclusions: Taking into account the obstetrical outcomes, it seems that the preferred option for radical RT is an endoscopic procedure with preservation of the uterine artery and the pelvic autonomic nerves. However, the safety of the endoscopic approach should be evaluated in prospective trials.

Keywords: abdominal cerclage; cervical cancer; fertility-sparing treatment; nerve-sparing technique; radical trachelectomy; uterine artery preservation.

Figure 1

Flowchart of the article selection process.

Figure 2

Studies concerning different approaches for and surgical steps during radical trachelectomy. The p-value was calculated using a contingency table. Articles with no data on the management of uterine arteries and autonomic nerves were not included in the calculation.

Figure 3

The trend in the use of uterine-sparing and nerve-sparing surgery for radical trachelectomy. The figure presents the trends in publishing studies concerning radical trachelectomy using nerve-sparing techniques and uterine artery preservation.

Figure 4

The relationship between surgical techniques during radical trachelectomy and oncological and obstetrical outcomes. The ‘attempt for pregnancy rate’ was defined as the rate of patients who declared trying for pregnancy. The ‘pregnancy rate’ was defined as the rate of patients who became pregnant. The ‘live birth rate’ was defined as the rate of live births after 24 weeks of pregnancy among all patients who have had RT. The ‘pregnancy rate among attempt’, which was defined as the pregnancy rate among patients who attempted to become pregnant. The ‘preterm delivery rate’ was calculated as the rate of deliveries before 37 weeks of gestation among all live births.