IMR Press / EJGO / Volume 42 / Issue 2 / DOI: 10.31083/j.ejgo.2021.02.2346
Open Access Original Research
Morbidity of radical hysterectomy combined with caesarean section in pregnant patients with cervical cancer
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1 Department of Gynaecological Oncology, Amsterdam University Medical Centre, 1105 AZ Amsterdam, The Netherlands
2 Department of Obstetrics, Amsterdam University Medical Centre, 1105 AZ Amsterdam, The Netherlands
Eur. J. Gynaecol. Oncol. 2021, 42(2), 300–306;
Submitted: 11 December 2020 | Revised: 22 December 2020 | Accepted: 24 December 2020 | Published: 15 April 2021

Objectives: In pregnant patients with early stage cervical cancer, the preferred mode of delivery is a caesarean section (CS), which can be combined with a radical hysterectomy and pelvic lymphadenectomy (RHLD). The aim of this study was to compare this group of patients with non-pregnant cervical cancer patients treated by RHLD alone with regard to perioperative morbidity, oncological outcomes, and perinatal outcomes. Methods: We retrospectively reviewed all consecutive patients diagnosed with early stage cervical cancer during pregnancy who were treated by CS and RHLD at our institution. Non-pregnant counterparts served as controls and were matched on a 1 : 2 ratio. Key outcomes were perioperative complications, cancer outcome and perinatal outcome. Results: Nineteen pregnant women treated with a CS and RHLD were matched with 38 non-pregnant control patients with cervical cancer who underwent a RHLD. The only difference in morbidity was a higher estimated perioperative blood loss in the pregnant group (1600 mL) compared to the control group (800 mL; P = 0.001), resulting in seven (36.8%) and eight (21.1%) blood transfusions (P = 0.22; OR 2.19; 95% CI 0.65 to 7.38), respectively. Conclusion: Oncological outcomes were similar with 5-year overall survival rates of 94% in the pregnant group and 95% in the non-pregnant group. The neonatal survival rate was 100%. Complication rates and oncological outcomes after treatment with RHLD were comparable for pregnant and non-pregnant patients with early stage cervical cancer. Therefore we feel that it is safe to combine a CS with a RHLD in pregnant patients with early stage cervical cancer.

Uterine cervical cancer
Postoperative complications
Caesarean section
Radical hysterectomy
Perinatal mortality
Fig. 1.
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