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Radical Trachelectomy for Early-Stage Cervical Cancer: A Survey of the Society of Gynecologic Oncology and Gynecologic Oncology Fellows-in-Training
  1. Sara J. Churchill, MD*,
  2. Shannon Armbruster, MD,
  3. Kathleen M. Schmeler, MD,
  4. Michael Frumovitz, MD,
  5. Marilyn Greer, PhD§,
  6. Jaime Garcia, MA§,
  7. Glenda Redworth, MS§ and
  8. Pedro T. Ramirez, MD
  1. *Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA;
  2. Department of Obstetrics and Gynecology, Summa Health System, Akron, OH;
  3. Division of Surgery, Department of Gynecologic Oncology and Reproductive Medicine, and
  4. §Department of Institutional Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
  1. Address correspondence and reprint requests to Pedro T. Ramirez, MD, Department of Gynecologic Oncology, Unit 1362, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030. E-mail: peramire{at}mdanderson.org.

Abstract

Objective The aim of this study was to survey gynecologic oncologists and fellows-in-training regarding the role of radical trachelectomy (RT) and conservative surgery in patients with early-stage cervical cancer.

Materials and Methods From June 2012 to September 2012, the Society of Gynecologic Oncology member practitioners (n = 1353) and gynecologic oncology fellows (n = 156) were sent group-specific surveys investigating current practice, training, and the future of RT for early-stage cervical cancer management.

Results Twenty-two percent of practitioners (n = 303) and 24.4% of fellows (n = 38) completed the surveys. Of the practitioners, 50% (n = 148) report performing RT, 98% (n = 269) support RT as treatment for squamous carcinoma, and 71% (n = 195) confirm the use of RT for adenocarcinoma. Most practitioners offer RT treatment for stages IA2 to IB1 smaller than 2 cm (n = 209, 76.8%) regardless of grade (77.7%) or lymph vascular space invasion (n = 211, 79.3%). Only 8% (n = 23) of practitioners feel that RT is appropriate for stage IBI larger than 2 cm. Respectively, both practitioners and fellows most frequently perform robotic-assisted (47.0%, n = 101 and 59.1%, n = 13) and abdominal (40.5%, n = 87 and 68.2%, n = 15) RT approaches. After training, fellows project the use of robotic-assisted (71%, n = 22) or abdominal methods (58.1%, n = 18). Overall, 75% (n = 227) of practitioners and 60% (n = 23) of fellows speculate that over the next 5 years, less radical procedures will be used to manage early-stage cervical cancer.

Conclusions Our findings suggest that practitioners and fellows believe RT remains an option for early-stage cervical cancer patients. However, a significant proportion of all respondents believe that less radical surgery may be a future consideration for patients with low-risk early-stage cervical cancer.

  • Radical trachelectomy
  • Conservative surgery
  • Cervical cancer

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Footnotes

  • Supported in part by the National Institutes of Health through MD Anderson’s Cancer Center Support grant CA016672.

  • The authors declare no conflicts of interest.

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