{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T17:00:07Z","timestamp":1790269207843,"version":"4.1.0"},"reference-count":29,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2022,12,10]],"date-time":"2022-12-10T00:00:00Z","timestamp":1670630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction. Cervical cancer is currently the fourth most common cancer in women and in the poorest countries this neoplasia still represents a widespread and potentially lethal disease. We present a rare case of cervical cancer in pregnancy, analyzing the historical changes behind the procedure of radical hysterectomy for cervical cancer and discussing variations in surgical techniques and anatomical definitions that have since been proposed. Results. We present the case of a 33-year-old patient who attended with vaginal bleeding in the second trimester of pregnancy. Examination revealed an abnormal looking cervix, with investigations concluding stage IIb squamous cell carcinoma. Following extensive discussion regarding management options, the patient went on to have a peripartum foetocidal type III nerve sparing radical Wertheim hysterectomy at 18 weeks gestation with conservation and transposition of the ovaries above the level of the pelvic brim. The patient recovered well without significant morbidity and received further input from fertility and psychological medical teams in addition to adjuvant treatment within the department of clinical oncology. Discussion. This case represents several elements of great interest and learning. Notably, we highlight this both due to the surgical challenges that a gravid uterus presents in the execution of a radical hysterectomy; and regarding the compassionate care demonstrated by the team - not only in supporting the patient and her partner in a period of profound turmoil in terms of the management of their cancer diagnosis and unborn child, but also regarding the uncertainty in consideration of the oncological and fertility related outcomes. Conclusion. This manuscript adds to the growing literature on the appropriate use of radical surgery for cervical cancer, more specifically during pregnancy and in consideration of such ethical dilemma, where management guidelines do not exist to aid clinicians further in their provision of treatment.<\/jats:p>","DOI":"10.3390\/jcm11247352","type":"journal-article","created":{"date-parts":[[2022,12,12]],"date-time":"2022-12-12T04:34:20Z","timestamp":1670819660000},"page":"7352","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Approach to Radical Hysterectomy for Cervical Cancer in Pregnancy: Surgical Pathway and Ethical Considerations"],"prefix":"10.3390","volume":"11","author":[{"given":"Rocco","family":"Guerrisi","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u2018Filippo Del Ponte\u2019 Hospital, University of Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7407-8247","authenticated-orcid":false,"given":"Sarah","family":"Smyth","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford University Hospital, NHS Foundation Trust, Oxford OX3 9DU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3106-0730","authenticated-orcid":false,"given":"Lamiese","family":"Ismail","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford University Hospital, NHS Foundation Trust, Oxford OX3 9DU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Horne","sequence":"additional","affiliation":[{"name":"Department of Clinical Oncology, Churchill Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford OX3 7LE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, \u201cSpedali Civili\u201d Hospital, University of Brescia, 25121 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3293-5321","authenticated-orcid":false,"given":"Hooman","family":"Soleymani majd","sequence":"additional","affiliation":[{"name":"Nuffield Department of Women\u2019s Reproductive Health, Medical Sciences Division, Oxford University, Oxford OX3 9DU, UK"},{"name":"Department of Gynaecological Oncology, Churchill Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford OX3 7LE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,10]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"A review of cervical cancer: Incidence and disparities","volume":"112","author":"Buskwofie","year":"2020","journal-title":"J. Natl. Med. Assoc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e191","DOI":"10.1016\/S2214-109X(19)30482-6","article-title":"Estimates of incidence and mortality of cervical cancer in 2018: A worldwide analysis","volume":"8","author":"Arbyn","year":"2020","journal-title":"Lancet Glob. Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/978-3-540-71274-9_7","article-title":"Cervical and endometrial cancer during pregnancy","volume":"178","author":"Kehoe","year":"2008","journal-title":"Recent Results Cancer Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"366","DOI":"10.3109\/01443615.2015.1065235","article-title":"Management of cervical cancer during pregnancy","volume":"36","author":"Gungorduk","year":"2016","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.radonc.2018.03.003","article-title":"The European Society of Gynaecological Oncology\/European Society for Radiotherapy and Oncology\/European Society of Pathology guidelines for the management of patients with cervical cancer","volume":"127","author":"Cibula","year":"2018","journal-title":"Radiother. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1093\/annonc\/mdz228","article-title":"Gynecologic cancers in pregnancy: Guidelines based on a third international consensus meeting","volume":"30","author":"Amant","year":"2019","journal-title":"Ann. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1016\/S1470-2045(19)30389-4","article-title":"Surgical resection based on ontogenetic cancer field theory for cervical cancer: Mature results from a single-centre, prospective, observational, cohort study","volume":"20","author":"Wolf","year":"2019","journal-title":"Lancet Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.3802\/jgo.2022.33.e9","article-title":"Total mesometrial resection (TMMR) for cervical cancer FIGO IB-IIA: First results from the multicentric TMMR register study","volume":"33","author":"Buderath","year":"2022","journal-title":"J. Gynecol. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kostov, S., Slavchev, S., Dzhenkov, D., Mitev, D., and Yordanov, A. (2020). Avascular spaces of the female pelvis-clinical applications in obstetrics and gynecology. J. Clin. Med., 9.","DOI":"10.3390\/jcm9051460"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1002\/ijgo.12616","article-title":"Surgical pelvic anatomy in gynecologic oncology","volume":"143","author":"Puntambekar","year":"2018","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1111\/j.1525-1438.2003.13608.x","article-title":"Total mesometrial resection: High resolution nerve-sparing radical hysterectomy based on developmentally defined surgical anatomy","volume":"13","author":"Horn","year":"2003","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_12","first-page":"e1","article-title":"The modified radical peripartum cesarean hysterectomy (Soleymani-Alazzam-Collins technique): A systematic, safe procedure for the management of severe placenta accreta spectrum","volume":"225","author":"Majd","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_13","first-page":"169","article-title":"The extended abdominal operation for carcinoma uteri (based on 500 operative cases)","volume":"66","author":"Wertheim","year":"1912","journal-title":"Am. J. Obs. Dis. Women Child."},{"key":"ref_14","first-page":"335","article-title":"Radical abdominal hysterectomy for cancer of the cervix uteri","volume":"33","author":"Okabayashi","year":"1921","journal-title":"Surg. Gynecol. Obstet."},{"key":"ref_15","first-page":"195","article-title":"Carcinoma of the cervix\u2014The Wertheim operation","volume":"78","author":"Meigs","year":"1944","journal-title":"Surg. Gynecol. Obstet."},{"key":"ref_16","first-page":"265","article-title":"Five classes of extended hysterectomy for women with cervical cancer","volume":"44","author":"Piver","year":"1974","journal-title":"Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S1470-2045(08)70074-3","article-title":"Classification of radical hysterectomy","volume":"9","author":"Querleu","year":"2008","journal-title":"Lancet Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.ygyno.2011.04.029","article-title":"New classification system of radical hysterectomy: Emphasis on a three-dimensional anatomic template for parametrial resection","volume":"122","author":"Cibula","year":"2011","journal-title":"Gynecol. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1016\/S1470-2045(05)70324-7","article-title":"Association between the mesenchymal compartment of uterovaginal organogenesis and local tumour spread in stage IB-IIB cervical carcinoma: A prospective study","volume":"6","author":"Horn","year":"2005","journal-title":"Lancet Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/S1470-2045(09)70100-7","article-title":"Resection of the embryologically defined uterovaginal (M\u00fcllerian) compartment and pelvic control in patients with cervical cancer: A prospective analysis","volume":"10","author":"Horn","year":"2009","journal-title":"Lancet Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.ygyno.2017.05.007","article-title":"Extended mesometrial resection (EMMR): Surgical approach to the treatment of locally advanced cervical cancer based on the theory of ontogenetic cancer fields","volume":"146","author":"Wolf","year":"2017","journal-title":"Gynecol. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1016\/S1470-2045(20)30388-0","article-title":"The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: A national, population-based, modelling study","volume":"21","author":"Maringe","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1038\/s41416-021-01275-3","article-title":"Recovery strategies following COVID-19 disruption to cervical cancer screening and their impact on excess diagnoses","volume":"124","author":"Castanon","year":"2021","journal-title":"Br. J. Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1093\/annonc\/mdi084","article-title":"Management and clinical outcomes of pregnant patients with invasive cervical cancer","volume":"16","author":"Germann","year":"2005","journal-title":"Ann. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"vi160-70","DOI":"10.1093\/annonc\/mdt199","article-title":"Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"24","author":"Peccatori","year":"2013","journal-title":"Ann. Oncol."},{"key":"ref_26","first-page":"199","article-title":"Invasive cervical cancer complicating intrauterine pregnancy: Treatment with radical hysterectomy","volume":"80","author":"Monk","year":"1992","journal-title":"Obstet. Gynecol."},{"key":"ref_27","first-page":"79","article-title":"Radical hysterectomy for invasive cervical cancer during pregnancy: A retrospective analysis of a single institution experience","volume":"30","author":"Watanabe","year":"2009","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/GCO.0000000000000186","article-title":"Latest developments and techniques in gynaecological oncology surgery","volume":"27","author":"Majd","year":"2015","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1002\/pon.4301","article-title":"Psychological distress and cognitive coping in pregnant women diagnosed with cancer and their partners","volume":"26","author":"Vandenbroucke","year":"2017","journal-title":"Psychooncology"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/24\/7352\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:37:58Z","timestamp":1760146678000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/24\/7352"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,10]]},"references-count":29,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["jcm11247352"],"URL":"https:\/\/doi.org\/10.3390\/jcm11247352","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,10]]}}}