Oncologic and Fertility Outcomes Following Radical Trachelectomy in Early-stage Cervical Cancer: Insights from a Single-institution in Malaysia

Abstract

Aims: Radical trachelectomy is a fertility-preserving surgical option for early-stage cervical cancer. It remains an uncommon choice among women, with limited cases reported in Malaysia. This case series explores the fertility and oncologic outcomes of radical trachelectomy in managing early cervical cancer among women of reproductive age in our institution. Study Design: We retrospectively evaluated five patients who underwent abdominal radical trachelectomy in National Cancer Institute, Putrajaya for a median follow-up period of 3 years. Place and Duration of Study: Department of Gynecology Oncology at National Cancer Institute, Putrajaya Malaysia between January 2016 and December 2023. Methodology: The medical records of all patients who underwent abdominal radical trachelectomy at National Cancer Institute, Putrajaya Malaysia were reviewed. Data were obtained from medical and pathologic records. Data collected included age, parity, stage, preoperative tissue diagnosis, tumor size, evidence of lymph vascular space invasion, estimated blood loss, margin, final histopathology report, surgical complication, obstetric outcome and additional chemoradiotherapy treatment. Results: A total of 104 new patients were diagnosed with early cervical cancer. During this period, 99 radical hysterectomies and five radical trachelectomies were performed. The patients’ ages ranged from 27 to 40 years old. The median estimated blood loss was 400mL, median surgical time was 320 minutes and median length of hospitalization was 5 days. The oncological outcomes varied among the patients. Four out of five patients survived and remain disease-free, while one experienced recurrence, requiring debulking surgery and additional chemoradiation therapy. Reported complications included cervical stenosis, pseudocyst formation and wound breakdown, all of which were manageable without long-term effects. Notably, three patients achieved pregnancy, although only one resulted in a live birth. Conclusion: Despite the rarity of the radical trachelectomy procedure in Malaysia, this case series highlights favorable outcomes, manageable complications, and the possibility of successful pregnancies with a risk of preterm labor, demonstrating its role in addressing both oncological and reproductive goals in women with early-stage cervical cancer.