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Expanding the Indications for Radical Trachelectomy: A Report on 29 Patients With Stage IB1 Tumors Measuring 2 to 4 Centimeters
  1. Stephanie L. Wethington, MD*,
  2. Yukio Sonoda, MD*,,
  3. Kay J. Park, MD,
  4. Kaled M. Alektiar, MD§,
  5. William P. Tew, MD,
  6. Dennis S. Chi, MD*,,
  7. Mario M. Leitao, MD*,,
  8. Elizabeth L. Jewell, MD*,,
  9. Richard R. Barakat, MD*, and
  10. Nadeem R. Abu-Rustum, MD*,
  1. *Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY;
  2. Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY;
  3. Department of Pathology,
  4. §Department of Radiation Oncology, and
  5. Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.
  1. Address correspondence and reprint requests to Nadeem R. Abu-Rustum, MD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Box 225, New York, NY 10065, USA. E-mail:


Objectives Radical trachelectomy has enabled select women with stage I cervical cancer to maintain fertility after treatment. Tumor size greater than 2 cm has been considered a contraindication, and those patients denied trachelectomy. We report our trachelectomy experience with tumors measuring 2 to 4 cm.

Methods We retrospectively reviewed the medical records of all patients planned for fertility-sparing radical trachelectomy. Largest tumor dimension was determined by physical examination, preoperative magnetic resonance imaging, or pathologic evaluation. No patient received neoadjuvant chemotherapy.

Results Twenty-nine (26%) of 110 patients had stage IB1 disease with tumors 2 to 4 cm. Median age was 31 years (range, 22–40 years), and 83% were nulliparous. Thirteen patients (45%) had squamous cell carcinoma, 12 patients (41%) had adenocarcinoma, and 4 patients (14%) had adenosquamous carcinoma. Thirteen (45%) of 29 patients had positive pelvic nodes. All para-aortic nodes were negative. Owing to intraoperative frozen section, 13 patients (45%) underwent immediate hysterectomy and 1 patient (3%) definitive chemoradiation. Owing to high-risk features on final pathology, 6 patients (21%) who had retained their uterus received chemoradiation. Nine patients (31%) underwent a fertility-sparing procedure. At a median follow-up of 44 months (range, 1–90 months), there was one recurrence.

Conclusions Expanding radical trachelectomy inclusion criteria to women with 2- to 4-cm tumors allows for a fertility-sparing procedure in 30% of patients who would otherwise have been denied the option, with no compromise in oncologic outcome.

  • Trachelectomy
  • Cervical cancer
  • Fertility preservation

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  • The authors declare no conflicts of interest.