A rare case of abdominal radical trachelectomy following C-section for early-stage cervical cancer

Background: Cervical cancer is the most frequent cancer type encountered during pregnancy, with an incidence of between 1.4-4.6 cases per 100,000 births. Although there are regulations regarding the correct therapeutic procedure to follow in such circumstances, their application is often hampered by the patient's wishes. Case presentation: The authors describe the case of a pregnant patient (gestational age 25 weeks) who refused neoadjuvant chemotherapy for early-stage cervical cancer. She underwent a failed abdominal radical trachelectomy due to the large uterine volume and inadequate access to the parametria. The final surgical treatment was achieved at 32 gestational weeks when a C-section was performed. This was immediately followed by an abdominal radical trachelectomy with pelvic lymphadenectomy aimed at fertility preservation. Conclusions: The guidelines recommend neoadjuvant chemotherapy as the only pregnancy-preserving option for pregnancies past 22 gestational weeks. However, the patient in this case wished to protect the fetus from possible risks arising due to neoadjuvant chemotherapy. Hence, at the gestational age of 25 weeks she underwent a surgical procedure laden with many risks. The role of abdominal trachelectomy for early stage cervical cancer during pregnancy is still under debate due to the lack of multicenter randomized trials, despite its proven effectiveness in a relatively small number of cases.