title: Incidence, risk factors and treatment of cervical stenosis after radical trachelectomy: A systematic review.
abstract: OBJECTIVE
  Cervical stenosis is a major and specific postoperative complication following radical trachelectomy. The current article presents a review of studies describing the incidence, risk factors and treatment methods of cervical stenosis after this fertility sparing procedure.
  
  
  METHODS
  We searched PubMed, MEDLINE, Embase (January 1994 through November 2014) using the following terms: uterine cervix neoplasms, cervical cancer, radical trachelectomy, fertility sparing and fertility preservation. We included original articles and case series. Case reports, review articles, articles not in English and articles not mentioning cervical stenosis were all excluded.
  
  
  RESULTS
  We identified 1547 patients. The incidence rates of cervical stenosis ranged from 0% to 73.3% with an average rate of 10.5%. Among patients with abdominal, vaginal, laparoscopic and robotic radical trachelectomy, the incidences of cervical stenosis were 11.0%, 8.1%, 9.3% and 0%, respectively. In patients in whom whether cerclage was placed or not, the incidence rates of cervical stenosis were 8.6% and 3.0%, respectively (P=NS). Among those in whom whether anti-stenosis tools were placed or not, the incidences of cervical stenosis were 4.6% and 12.7%, respectively (P<0.001). Cervical stenosis was a potential cause of infertility and increased the use of artificial reproductive technology. Surgical dilatation resolved stenosis in the majority of cases but had to be repeated.
  
  
  CONCLUSIONS
  Cervical stenosis is related to the surgical approach, cerclage and anti-stenosis tools utilised. It affects not only the quality of life but also obstetrical outcomes of patients following radical trachelectomy. Greater attention should be given to the prevention and treatment of this complication.
authors.affiliation: Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China.
authors.forename: Xiaoqi
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, PR China.
authors.forename: Jin
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, PR China. Electronic address: docwuxh@hotmail.com.
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Wu
mesh_terms: D003251:Constriction, Pathologic; D005260:Female; D059247:Fertility Preservation; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D016896:Treatment Outcome; D002577:Uterine Cervical Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy*; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Cervical cancer; Cervical stenosis; Radical trachelectomy