Introduction/Background Although abdominal radical trachelectomy (ART) has become a recommended fertility-sparing procedure by NCCN guideline since 2015, the relative contraindication of a tumor ≥2 cm has been questioned.

Methodology We conducted a retrospective review of a prospectively maintained database of patients undergoing ART at our institution from 04/2004 to 12/2017. All patients were followed postoperatively.

Results Of the 343 patients who underwent planned ART, 142 (41.3%) had IB1cervical cancer whose tumors ≥2 cm in size. Among them, 10 had NACT while the other 132 patients underwent upfront ART. In the whole cohort, two hundred and seventy-nine patients had squamous carcinomas (SCC), 53 had pure adenocarcinomas (AC), and 11 had adenosquamous carcinomas (AS). With a median follow up of 65 months, 12 patients (3.4%) had recurrence, and five patients (1.5%) died. The cumulative 5-year recurrence-free survival and overall survival rates for the whole cohort were 96.3 and 98.6%, respectively. Among 12 recurrent cases, 8 had tumor larger than 2cm. The recurrence rate in women with tumours ≥2 cm was comparable to that in patients with tumours <2 cm (P = NS). However, the recurrence rate was significantly higher in patients with AS histology than those with AC and SCC histology (P<0.05).

Conclusion These results further supported that upfront ART was a safe option for well-selected patients with stage IB1 cervical cancers ≥2 cm. As for NACT, we need larger sample and longer follow-up to observe the oncological and obstetric results. However, if patients with tumours ≥2 cm have AS histology, they should be advised with great caution when contemplating ART.

Disclosure Nothing to disclose.