title: First case of vaginal radical trachelectomy in a pregnant Japanese woman.
abstract: A diagnosis of cervical cancer during pregnancy poses difficult management and ethical problems. Survival of the patient is the foremost concern, but fetal viability and well-being must also be addressed. Radical trachelectomy (RT) has recently begun to be performed as a possible treatment modality for early stage invasive uterine cervical cancer in pregnant patients who would like to continue their pregnancy. A 32-year-old Japanese woman visited a local hospital for prenatal care, and was diagnosed with a FIGO I B1 adenocarcinoma of the uterine cervix. She had a strong desire to avoid pregnancy termination, so she was admitted to our hospital for fertility-preserving surgery. After extensive counseling, vaginal radical trachelectomy with abdominal pelvic lymphadenectomy was performed in the 16th gestational week. The excised uterine cervix and lymph nodes were pathologically negative for cancer. To maintain her pregnancy, daily vaginal disinfection with povidone iodine, bed rest, and administration of ritodrine and an ulinastatin vaginal suppository were continued until the delivery. At 34 weeks' gestation, an emergency cesarean section was performed because of sudden premature rupture of the membranes. A baby girl was born weighing 2112 g, with Apgar score of 8/9. The mother remains without evidence of recurrence at the time of this report. This is the first case of successful pregnancy and delivery in Japan after vaginal RT.
authors.affiliation: Department of Obstetrics and Gynecology, Sapporo Medical University, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido 064-8453, Japan.
authors.forename: Nanako
authors.initials: N
authors.lastname: Iwami
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Ishioka
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Endo
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Baba
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Nagasawa
authors.forename: Madoka
authors.initials: M
authors.lastname: Takahashi
authors.forename: Asuka
authors.initials: A
authors.lastname: Sugio
authors.forename: Sakura
authors.initials: S
authors.lastname: Takada
authors.forename: Tasuku
authors.initials: T
authors.lastname: Mariya
authors.forename: Masahiro
authors.initials: M
authors.lastname: Mizunuma
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Saito
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D000328:Adult; D002585:Cesarean Section; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007044:Hysterectomy; D007231:Infant, Newborn; D007564:Japan; D008197:Lymph Node Excision; D009367:Neoplasm Staging; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology / Q000601:surgery*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*