Elaborate anesthetic management of cesarean section followed by abdominal radical hysterectomy for uterine cervical cancer: case report

Cervical cancer is occasionally detected in pregnant women. If the patient desires the pregnancy, surgical treatment is recommended for cervical cancer at stage IA2 or IB1 when the fetus is mature enough to be delivered. A combination of spinal and epidural anesthesia for cesarean section, followed by general intravenous anesthesia for abdominal radical hysterectomy, was conducted in this case. Two catheters were placed in the upper extremity before anesthesia using ultrasound guidance for invasive arterial pressure monitoring and central venous access. General anesthesia was administered for the abdominal radical hysterectomy under propofol and remifentanil target-controlled infusion to maintain bispectral index at 40–50. Postoperative analgesia was administered via the epidural catheter. The neonate (2475 g) was delivered in 6 minutes, and the Apgar score was 10-10-10 at 1, 5, and 10 minutes. After the surgery, which took 4 h 18 min in total, the patient awakened from anesthesia and was extubated without complications.

Cervical cancer; Anesthetic management; Cesarean ection; Abdominal radical hysterectomy

[1] Duggan B, Muderspach LI, Roman LD, Curtin JP, d’Ablaing G, Morrow CP. Cervical cancer in pregnancy: reporting on planned delay in therapy. Obstetrics and Gynecology. 1993; 82: 598–602.

[2] Lihui W, Mingzhu L. Treatment strategy of cervical cancer in pregnancy. Chinese Journal of Practical Gynecology and obstetrics. 2018; 34: 1079–1084.

[3] Lihui W, Yun Z, Xing X, Zhixue You, Hui Bi, Beihua Kong, et al. Expert consensus on the management of pregnancy with cervical cancer. Chinese Journal of Clinical Obstetrics and Gynecology. 2018; 19: 190–192.

[4] Amant F, Halaska MJ, Fumagalli M, Dahl Steffensen K, Lok C, Van Calsteren K, et al. Gynecologic cancers in pregnancy: guidelines of a second international consensus meeting. International Journal of Gynecological Cancer. 2014; 24: 394–403.

[5] Sadri Nahand J, Moghoofei M, Salmaninejad A, Bahmanpour Z, Karimzadeh M, Nasiri M, et al. Pathogenic role of exosomes and micrornas in hpv-mediated inflammation and cervical cancer: a review. International Journal of Cancer. 2020; 146: 305–320.

[6] Nahand JS, Taghizadeh‐boroujeni S, Karimzadeh M, Borran S, Pourhanifeh MH, Moghoofei M, et al. MicroRNAs: New prognostic, diagnostic, and therapeutic biomarkers in cervical cancer. Journal of Cellular Physiology. 2019; 234: 17064–17099.

[7] Ghasemi F, Shafiee M, Banikazemi Z, Pourhanifeh MH, Khanbabaei H, Shamshirian A, et al. Curcumin inhibits NF-kB and Wnt/beta-catenin pathways in cervical cancer cells. Pathology- Research and Practice. 2019; 215: 152556.

[8] Shafabakhsh R, Reiter RJ, Mirzaei H, Teymoordash SN, Asemi Z. Melatonin: a new inhibitor agent for cervical cancer treatment. Journal of Cellular Physiology. 2019; 234: 21670–21682.

[9] Kozono Y, Kadogami D, Seo K, Hanada T, Deguchi M, Yamamoto R, et al. A case of intrauterine fetal death during abdominal radical trachelectomy in a pregnant woman. Advanced Obstetrics & Gynecology. 2014; 66: 299–302.

[10] Abu-Rustum NR, Tal MN, DeLair D, Shih K, Sonoda Y. Radical abdominal trachelectomy for stage IB1 cervical cancer at 15-week gestation. Gynecologic Oncology. 2010; 116: 151–152.

[11] Shinde P, Jasapara A, Bansode K, Bunage R, Mulay A, Shetty V. A comparative study of safety and efficacy of ultrasound-guided infra-clavicular axillary vein cannulation versus ultrasound- guided internal jugular vein cannulation in adult cardiac surgical patients. Annals of Cardiac Anaesthesia. 2019; 22: 177–186.

[12] Nelson G, Altman AD, Nick A, Meyer LA, Ramirez PT, Achtari C, et al. Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS(R)) society recommendations-Part II. Gynecologic Oncology. 2016; 140: 323–332.