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BJOG. 2019 Aug;126(9):1169-1174. doi: 10.1111/1471-0528.15621. Epub 2019 Feb 28.

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

Li X1,2, Li J1,2, Jiang Z2,3, Xia L1,2, Ju X1,2, Chen X1,2, Wu X1,2.

Author information

1
Department of Gynaecologic Oncology, Fudan University Shanghai Cancer Centre, Shanghai, China.
2
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
3
Department of Radiology, Fudan University Shanghai Cancer Centre, Shanghai, China.

Abstract

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.

KEYWORDS:

Abdominal radical trachelectomy; cervical cancer; fertility-sparing surgery; oncological result; recurrent risk factor

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PMID:
30663205
DOI:
10.1111/1471-0528.15621
[Indexed for MEDLINE]

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