Objective: To apply the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system to all patients who underwent trachelectomy in our previous study and to update the oncologic and obstetric results. Methods: We retrospectively reviewed the medical records of patients in whom abdominal trachelectomy was attempted between June 2005 and September 2021. The FIGO 2018 staging system for cervical cancer was applied to all patients. Results: Abdominal trachelectomy was attempted for 265 patients. Trachelectomy was converted to hysterectomy in 35 patients, and trachelectomy was completed successfully in 230 (conversion rate: 13%). Applying the FIGO 2018 staging system, 40% of the patients who underwent radical trachelectomy had stage IA tumors. Among 71 patients who had tumors measuring ≥2 cm, 8 patients were classified as stage IA1 and 14 as stage IA2. Overall recurrence and mortality rates were 2.2% and 1.3%, respectively. One hundred twelve patients attempted to conceive after trachelectomy; 69 pregnancies were achieved in 46 patients (pregnancy rate: 41%). Twenty-three pregnancies ended in first-trimester miscarriage, and 41 infants were delivered between gestational weeks 23 and 37; 16 were deliveries at term (39%) and 25 were premature deliveries (61%). Conclusion This study suggested that patients judged to be ineligible for trachelectomy and patients receiving overtreatment will continue to appear using the current standard eligibility criteria. With the revisions to the FIGO 2018 staging system, the preoperative eligibility criteria for trachelectomy, which were based on the FIGO 2009 staging system and tumor size, should be changed.

Objective: For oncologic safety, vaginal radical trachelectomy is generally performed only in patients with cervical cancers smaller than 2 cm. However, because inclusion criteria for abdominal trachelectomy are controversial, we evaluated the safety of abdominal trachelectomy for cervical cancers ≥2 cm. Methods: We began performing abdominal trachelectomies at our institution in 2005, primarily for squamous cell carcinoma ≤3 cm or adenocarcinoma/adenosquamous carcinoma ≤2 cm. If a positive sentinel lymph node or cervical margin was diagnosed intraoperatively by frozen section, the trachelectomy was converted to a hysterectomy. Medical records of these patients were reviewed retrospectively. Patients who had undergone simple abdominal trachelectomy were excluded from this study. Results: We attempted trachelectomy in 212 patients. Among the 135 patients with tumors <2 cm, trachelectomy was successful in 120, one of whom developed recurrence and none of whom died of their disease. Among 77 patients with tumors ≥2 cm, trachelectomy was successful in 62, 2 of whom developed recurrence and 1 of whom died of her disease. The overall relapse rate after trachelectomy was 1.6% (0.8% in <2 cm group and 3.2% in ≥2 cm group), and the mortality rate was 0.5% (0% in <2 cm group and 1.6% in ≥2 cm group).Recurrence-free survival (p=0.303) and overall survival (p=0.193) did not differ significantly between the <2 cm and ≥2 cm groups. Conclusions Abdominal trachelectomy with intraoperative frozen sections of sentinel lymph nodes and cervical margins is oncologically safe, even in patients with tumors ≥2 cm.

It is well known that eccentric exercise induces muscle damage that is characterized by a prolonged decrease in muscle strength and range of motion, development of delayed onset muscle soreness. The previous studies showed that hold-relax stretching (HRS) was effective for improving the decreases in range of motion and muscle soreness. In addition, modified proprioceptive neuromuscular facilitation stretching (mPNF) was an equally effective for HRS. However, it was unclear whether there are differences between acute effects of HRS and mPNF on muscle strength and muscle soreness in eccentrically damaged muscle. Therefore, the present study aimed to compare the acute effects of HRS with those of mPNF on muscle strength and soreness in eccentrically damaged muscle. The participants comprised 40 volunteers randomly assigned to either the HRS group (N = 20) or the mPNF group (N = 20). Initially, the participants of both groups performed 60 maximal eccentric contractions of the knee extensors. Two days after this exercise, each group performed either HRS or mPNF for 60 s at a time and repeated them six times for a total of 360 s. Muscle strength and soreness during stretching and contraction were measured before and immediately after HRS and mPNF. The results showed that the muscle soreness observed after eccentric contraction significantly decreased immediately after both HRS and mPNF. In addition, there were no significant changes in muscle strength immediately after both HRS and mPNF. These results suggest that while both HRS and mPNF can effectively decrease muscle soreness without reducing performance.