Reconstructed uterine length is critical for the prevention of cervical stenosis following abdominal trachelectomy in cervical cancer patients

• Published in: The journal of obstetrics and gynaecology research Vol. 46; no. 2; pp. 328 - 336
• Main Authors: Nakajima, Takahiro, Kasuga, Akiko, Hara‐Yamashita, Aki, Ikeda, Yuji, Asai‐Sato, Mikiko, Nakao, Takehiro, Hayashi, Chuyu, Takeya, Chiaki, Adachi, Katsuyuki, Tsuruga, Tetsushi, Matsumoto, Yoko, Arimoto, Takahide, Nagamatsu, Takeshi, Oda, Katsutoshi, Komatsu, Atsushi, Chishima, Fumihisa, Osuga, Yutaka, Fujii, Tomoyuki, Kawana, Kei
• Format: Journal Article
• Language: English
• Published: Kyoto, Japan John Wiley & Sons Australia, Ltd 01.02.2020; Wiley Subscription Services, Inc
• Subjects: Abdomen; abdominal trachelectomy; Cervical cancer; cervical stenosis; fertility‐sparing surgery; Human papillomavirus; Multivariate analysis; Risk factors; Stenosis; Surgery; Ultrasound; Uterus; Vagina; cervical stenosis; fertility-sparing surgery; abdominal trachelectomy; cervical cancer
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/jog.14153

Aim Although the procedure of abdominal trachelectomy has been remarkably improved, preventing subsequent cervical stenosis remains challenging. In this study, we analyzed the clinicopathological risk factors for cervical stenosis to explore the appropriate surgical procedures for the prevention of cervical stenosis following trachelectomy. Methods Thirty‐two patients who underwent abdominal extended and radical trachelectomy were assessed retrospectively (median follow‐up period = 33 months). To evaluate the risk factors, the clinicopathological factors were analyzed by univariate and multivariate analyses. The reconstructed uterine length (UtL), that is, the length between the vaginal end of the neo‐cervix and the uterine fundus, was measured by transvaginal ultrasound after surgery. The cut‐off value for the UtL was assessed by a receiver operating characteristic (ROC) curve analysis. Results Cervical stenosis of any grade was observed in 12 patients (grade 1 = 9, grade 3b = 3). Among the various clinicopathological factors, the UtL and cervical length (CL) were significantly related to cervical stenosis following trachelectomy. The multivariate analysis revealed that the UtL, but not CL, is an independent risk factor for stenosis. The ROC curve analysis revealed that stenosis was significantly more likely to occur in patients with a UtL shorter than 53 mm (area under the ROC curve = 0.902). UtL in the patients who became pregnant was longer than that in the patients who did not. No evidence of recurrent cancer was observed during the follow‐up period. Conclusion Our proposed method may provide a functional reconstructed uterus with preserving fertility by remaining UtL more than 53 mm.