PT  - JOURNAL ARTICLE
AU  - Petra L.M. Zusterzeel
AU  - Fraukje J.M. Pol
AU  - Maaike van Ham
AU  - Ronald P. Zweemer
AU  - Ruud L.M. Bekkers
AU  - Leon F.A.G. Massuger
AU  - René H.M. Verheijen
TI  - Vaginal Radical Trachelectomy for Early-Stage Cervical Cancer: Increased Recurrence Risk for Adenocarcinoma
AID  - 10.1097/IGC.0000000000000763
DP  - 2016 Sep 01
TA  - International Journal of Gynecologic Cancer
PG  - 1293--1299
VI  - 26
IP  - 7
4099  - http://ijgc.bmj.com/content/26/7/1293.short
4100  - http://ijgc.bmj.com/content/26/7/1293.full
SO  - Int J Gynecol Cancer2016 Sep 01; 26
AB  - Objective To evaluate consecutive vaginal radical trachelectomies (VRTs) in early-stage cervical cancer in the 2 main referral centers for fertility-preserving surgery in the Netherlands.Materials and Methods Oncology, fertility, and obstetrical data were recorded in a regional database of all VRTs without neoadjuvant chemotherapy performed in 2 major referral centers between 2000 and 2015.Results Most of the patients (91.7%) had stage IB1 disease. In 72.0%, squamous cell carcinoma was the histologic diagnosis; in 24.2%, adenocarcinoma; and in 3.8%, adenosquamous carcinoma. The median follow-up was 51 months.Nine (6.8%) recurrences occurred, 4 resulting in death of disease (death rate, 3.0%). Recurrence rates were 12.5% for adenocarcinoma, 20% for adenosquamous carcinoma, and 4.2% for squamous cell carcinoma (P < 0.01).From 117 women, data about fertility and obstetrical outcome were obtained. Almost 60% of women attempted to conceive after a VRT. Of these women, 40% needed fertility treatment. A total of 47 pregnancies were established, and a total of 37 children were born of which 30 (81.1%) were delivered after 32 weeks of gestational age.Conclusions Nonsquamous cell histology and high-grade disease are associated with a significantly higher risk of recurrence in the univariate and multivariate analyses. Women with both these histology features should be counseled reticently for VRT.Pregnancies after VRT must be regarded as high-risk pregnancies with a high prematurity rate.