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2022-RA-1107-ESGO Hysterectomy after radical vaginal trachelectomy – is this a ‘must’ in early stage cervical cancer? Our 15 years clinical experience benchmarked with the current state of science
  1. Irina Cepraga,
  2. Valentina Auletta,
  3. Davit Bokhua,
  4. Angela Kather and
  5. Ingo B Runnebaum
  1. Gynaecology and Reproductive Medicine, Jena University Hospital, Jena, Germany


Introduction/Background Radical vaginal trachelectomy (RVT) is one treatment option for early stage cervical carcinoma in young patients wishing to preserve fertility. However, indication for second step hysterectomy following childbearing is not clear. We compared data of patients treated with RVT at Jena University Hospital with current literature.

Methodology Monocentric retrospective study. Analysis of recurrence, pregnancy and delivery rate for early stage cervical cancer patients who underwent RVT 2003–2017.

Results Out of 47 patients, 30 patients had a follow up (FU) of > 12 months and 15 patients > 48 months (median, 52, range, 12–120). Median age: 31 years (range, 23–41). Tumor stage: 11% pT1a1, 17% pT1a2, 67% pT1b1, 6% pT1b2. Three patients had N1 in final pathologic appraisal and 14 had LVSI1 or V1 or perineural infiltration. Histology: 19% adenocarcinoma, 79% squamous cell carcinoma. Pregnancy rate: 27% (75% live births, two full term and four pre-term births, one early miscarriage, one termination of pregnancy). Completion hysterectomy was performed in 11% (5/47) after a median of 58 months (range, 12–134) with no evidence of disease. Out of 30 patients, recurrence occurred in one patient (3.3%) on left ovary after 26 months. Tumor characteristics of this patient at diagnosis: pT1b1, squamous, N0, LVSI1. She underwent LRH type Q/M C1, but died 5 years after diagnosis because of disease progression. Outcome in our cohort was comparable to data from a review of Smith S. et al., 2020, analyzing 47 articles with 2566 patients: Median follow-up 48 months (range 2–202), median recurrence rate 3.3% (range 0–25%), median time to recurrence 26 months (range 8–44). Pregnancy rate was 23.9%, with a live-birth rate of 75.1%.

Conclusion RVT is an oncologically safe procedure for early cervical cancer with a median recurrence rate of 3.3%. Completion hysterectomy beyond 44 months of uneventful FU appears omittable.

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