We read with interest the case report by Gurney et al. We have authorship of the initial work in the field of abdominal radical trachelectomy and also ongoing studies examining the outcomes of patients treated in this manner. We were pleased to read of the successful outcomes relating to the patient investigated by Gurney et al and also the positive way in which fertility-sparing options were presented in the article.

However, we were slightly surprised to read that the patient was advised to undergo immediate radical hysterectomy and lymphadenectomy with fetus in situ on diagnosis, and it was only that she was extremely resistant to hysterectomy that conservative management options were discussed. Also, it was disappointing that only postpartum fertility-sparing management options were discussed and not options that were available to her during the pregnancy, such as neoadjuvant chemotherapy and those explored by Ungar et al in our case series.

Although 3 of 5 pregnancies were lost after radical trachelectomy in our case series as mentioned by Gurney et al, 2 of these 3 were in fact the first 2 cases performed. This is significant because the surgical technique was being improved constantly as both knowledge and experience of the procedure was gained. In particular, more careful dissection of the uterine arteriovenous tree was used in later surgeries. Therefore, current surgical outcomes during pregnancy are likely to be far more favorable, as demonstrated in the later cases of the series.

Currently all of the women treated in our series during pregnancy with radical abdominal trachelectomy have retained fertility with a median follow-up of more than 3 years.

We thank the authors for their work in producing this case report, which highlights that favorable oncological outcomes are possible using abdominal radical trachelectomy as a fertility-preserving surgical technique.