Radical abdominal trachelectomy for stage IB1 cervical cancer at 15-week gestation.

OBJECTIVE: The management of stage IB1 cervical cancer at 15 weeks pregnancy remains a significant challenge from both the oncologic and obstetrical standpoints. Abdominal trachelectomy has been recently described as a potential option in patients who have a very strong desire to attempt preservation of pregnancy and treat the cancer without delay. CASE: A 37-year-old female, presented for prenatal care in the first trimester and was diagnosed with a FIGO stage IB1 poorly differentiated lymphoepithelioma like cervical cancer on conization. After extensive counseling she underwent a radical abdominal trachelectomy with pelvic lymphadenectomy and placement of permanent cerclage at 15 weeks gestation. Final trachelectomy pathology revealed 7/19 mm invasion with no lymphovascular invasion, negative margins and nodes. She successfully carried the pregnancy to 39 weeks gestation and delivered a healthy female infant by elective planned cesarean hysterectomy. The patient remains without evidence of disease at the time of this report.
CONCLUSION: Recent advances in fertility-sparing surgery for stage IB1 cervical cancer lead to the successful utilization of radical abdominal trachelectomy during the early second trimester of pregnancy. This approach in early gestation is feasible and resulted in a favorable oncologic and obstetrical outcome. Radical trachelectomy may broaden the treatment options for pregnant women with stage IB1 cervical cancer who have a strong desire to avoid definitive pregnancy termination and commence treatment without delay.