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.