title: Reproductive outcomes of patients undergoing radical trachelectomy for early-stage cervical cancer.
abstract: OBJECTIVE
  To report the reproductive outcomes of patients undergoing fertility-preserving radical trachelectomy (RT) for the treatment of early-stage cervical cancer.
  
  
  METHODS
  We analyzed data from our institution's first 105 patients who underwent attempted fertility-sparing surgery with radical trachelectomy, pelvic lymphadenectomy, and cerclage from November 2001 to October 2010.
  
  
  RESULTS
  Of the 105 patients who underwent attempted RT, 77 (73%) did not require a conversion to radical hysterectomy or postoperative treatment. The median age was 32 (range, 25-38 years). Most patients (75%) had stage IB1 disease. Sixty-six patients (63%) were nulliparous. Thirty-five women were actively attempting conception 6 months after surgery, and 23 (66%) women were successful in conceiving: there were 20 live births, 3 elective terminations, and 4 spontaneous miscarriages. Four patients had 2 pregnancies each; all delivered their second pregnancy between 32 and 36 weeks. Cerclage erosion through the vaginal wall occurred in 6 cases and was treated by transvaginal removal of protruding suture material. One of these patients experienced a second trimester miscarriage.
  
  
  CONCLUSIONS
  The majority of women who attempted to conceive after radical trachelectomy were successful, and most of their pregnancies resulted in full-term births. Assisted reproduction played an important role in select women. Cerclage likely contributed to a post-trachelectomy uterine ability to carry a pregnancy to the third trimester. The second post-trachelectomy pregnancy appears to be at higher risk for preterm delivery than the first pregnancy.
authors.affiliation: Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: C H
authors.initials: CH
authors.lastname: Kim
authors.forename: N R
authors.initials: NR
authors.lastname: Abu-Rustum
authors.forename: D S
authors.initials: DS
authors.lastname: Chi
authors.forename: G J
authors.initials: GJ
authors.lastname: Gardner
authors.forename: M M
authors.initials: MM
authors.lastname: Leitao
authors.forename: J
authors.initials: J
authors.lastname: Carter
authors.forename: R R
authors.initials: RR
authors.lastname: Barakat
authors.forename: Y
authors.initials: Y
authors.lastname: Sonoda
mesh_terms: D000328:Adult; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D009367:Neoplasm Staging; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*