Oncological results and recurrent risk factors following abdominal radical trachelectomy: an updated series of 333 patients.

OBJECTIVE: To update the oncological results and identify recurrent risk factors in young patients with early stage cervical cancers following abdominal radical trachelectomy (ART). DESIGN: Retrospective study. SETTING: A university-based cancer hospital. POPULATION: Three hundred and thirty-three patients. METHODS: We conducted a retrospective analysis from a prospectively maintained database of patients undergoing ART from April 2004 to December 2017. MAIN OUTCOME MEASURES: Survival rate, clinicopathological factors related to recurrences. RESULTS: Two hundred and seventy-one patients had squamous carcinomas (SCC), 51 had pure adenocarcinomas (AC), and 11 had adenosquamous carcinomas (AS). One hundred thirty-two women (39.6%) had tumours ≥2 cm. With a median follow up of 56 months (range, 6-169), 11 patients (3.3%) had recurrence, and five patients (1.5%) died. The cumulative 5-year recurrence-free survival and overall survival rates were 96.3 and 98.6%, respectively. The recurrence rate in women with tumours ≥2 cm was comparable to that in patients with tumours <2 cm (5.3 versus 2.0%, respectively, P = NS). However, the recurrence rate was significantly higher in patients with AS histology than those with AC and SCC histology (18.2, 3.9, and 2.6%, respectively, P < 0.05). All of the recurrent patients with AS histology had tumours ≥2 cm. Multivariate analysis showed that the only independent risk factor for recurrence was histology type. CONCLUSIONS: This updated series showed a favourable survival rate following ART. These results further supported that ART was a safe option for well-selected patients with stage IB1 cervical cancers ≥2 cm. However, if patients with tumours ≥2 cm have AS histology, they should be advised with great caution when contemplating ART. TWEETABLE ABSTRACT: Abdominal radical trachelectomy could be a safe, fertility-sparing option for strictly selected patients with stage IA1-IB1 cervical cancers ≤4 cm.

Trends in Use and Survival Associated With Fertility-Sparing Trachelectomy for Young Women With Early-Stage Cervical Cancer.

OBJECTIVE: To assess the trends in use of trachelectomy in the United States and to examine the outcomes of the procedure compared with hysterectomy in young women with cervical cancer. METHODS: Data were analyzed from women younger than 50 years of age with stage IA2-IB2 cervical cancer treated with hysterectomy or trachelectomy from 2004 to 2014 who were registered in the National Cancer Database. After propensity score matching, we used Cox proportional hazard models to examine the association between treatment and survival. RESULTS: We identified 15,150 patients with cervical cancer, including 14,714 (97.1%) who underwent hysterectomy and 436 (2.9%) who underwent trachelectomy. Trachelectomy rates increased from 1.5% in 2004 to 3.8% by 2014 (P<.001). The greatest increase in the rate of trachelectomy was seen in women younger than 30 years of age (4.6% in 2004 to 17.0% in 2014, P<.001). Among women who underwent trachelectomy, 29.6% had tumors greater than 2 cm in diameter. In a multivariable model, younger women and those more recently diagnosed were more likely to undergo trachelectomy, whereas Medicaid recipients (risk ratio 0.39, 95% CI 0.28-0.54) and the uninsured (risk ratio 0.67, 95% CI 0.45-1.00) were less likely to undergo trachelectomy. After propensity score matching, there was no association between trachelectomy and the risk of mortality (hazard ratio 1.24, 95% CI 0.70-2.22) (mortality rate was 6.0% for hysterectomy vs 5.2% for trachelectomy). Similarly, 5-year survival rates were similar between trachelectomy and hysterectomy for all of the stages examined. CONCLUSIONS: Use of trachelectomy for early-stage cervical cancer has increased in the United States, particularly among women younger than 30 years of age. Within this population, survival is similar for trachelectomy and hysterectomy.

Perioperative Outcomes of Radical Trachelectomy in Early-Stage Cervical Cancer: Vaginal Versus Laparoscopic Approaches.

OBJECTIVE: This study aimed to compare the laparoscopic-assisted radical vaginal trachelectomy (LARVT) and laparoscopic radical trachelectomy (LRT) surgical approaches and provide outcome data on patients who have undergone radical trachelectomy. METHODS: We identified patients who had undergone LARVT or LRT at Samsung Medical Center between January 2005 and March 2013. RESULTS: A total of 38 patients were identified, and 21 patients had undergone LARVT, whereas 17 patients had undergone LRT. The median age was 32 years for both groups. Most of the patients had a squamous cell carcinoma (68.4%) and International Federation of Gynecology and Obstetrics stage IB1 disease (76.3%). Twenty (52.6%) of 38 patients had tumor size greater than 2 cm. There were no significant differences between groups in the baseline characteristics except for the tumor size. Patients undergoing LRT had significantly larger tumor size than patients undergoing LARVT (median tumor size, 2.7 cm [range, 1.2-3.7] vs 2.1 cm [range, 0.4-3.0], P = 0.032). Perioperative outcomes were similar between groups except for the decline of hemoglobin after surgery. The median decline of hemoglobin indicating blood loss was significantly smaller in the LRT group than in the LARVT group (1.8 g/dL [range, 0.5-3.5] vs 2.6 g/dL [range, 0.7-6.2], P = 0.017). Intraoperative complications occurred in 2 patients (9.5%, 2/21) in LARVT group. Although 52.6% of tumors were larger than 2 cm, recurrence occurred only in 3 (7.9%) patients who underwent LARVT. CONCLUSIONS: The study shows the feasibility of LRT, with the advantage of reduced blood loss. The LRT could be an alternative option for patients with large tumors. Further researches are needed to investigate the long-term outcomes.