title: Radical vaginal trachelectomy as a fertility-sparing procedure in women with early-stage cervical cancer-cumulative pregnancy rate in a series of 123 women.
abstract: OBJECTIVE
  To analyse the fertility rates, complications and recurrences in a group of women who have undergone radical vaginal trachelectomy and pelvic lymphadenectomy for early-stage cervical cancer.
  
  
  METHODS
  An observational series.
  
  
  METHODS
  A Gynaecological Oncology Centre.
  
  
  METHODS
  One hundred and twenty-three consecutive women who underwent radical vaginal trachelectomy and pelvic lymphadenectomy for early-stage cervical cancer.
  
  
  METHODS
  Data were collected prospectively. MAIN OUTCOME MEASURES Complications, recurrences, pregnancies and live births are presented as percentages of the total population. Fertility is presented as a 5-year cumulative rate, with women attempting to conceive as the denominator.
  
  
  RESULTS
  A total of 123 women were followed up for an average of 45 months. Eleven (8.9%) had completion treatment (two radical hysterectomies and nine chemoradiotherapy) at the time of initial treatment. There were three recurrences (2.7%) among the women who did not have completion treatment and two (18.2%) in those who did. There were 6 perioperative and 26 postoperative complications. Sixty-three women attempted pregnancy. There were 55 pregnancies in 26 women and 28 live births in 19. Three women had continuing pregnancies. The 5-year cumulative pregnancy rate among women trying to conceive was 52.8%. All but two women were delivered by classical caesarean section and seven (25.0%) babies were born at 31+6 weeks or less.
  
  
  CONCLUSIONS
  For selected women with early-stage cervical cancer, radical vaginal trachelectomy and pelvic lymphadenectomy are fertility-sparing options, with a low incidence of recurrence and acceptable cumulative conception rates. Complications are few, although there is a high premature labour and miscarriage rate among pregnant women.
authors.affiliation: The Gynaecological Cancer Centre, St Bartholomew's Hospital, West Smithfield, London, UK.
authors.forename: J H
authors.initials: JH
authors.lastname: Shepherd
authors.forename: C
authors.initials: C
authors.lastname: Spencer
authors.forename: J
authors.initials: J
authors.lastname: Herod
authors.forename: T E J
authors.initials: TE
authors.lastname: Ind
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D001723:Birth Rate; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D007752:Obstetric Labor, Premature / Q000209:etiology; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000209:etiology*; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D014621:Vagina / Q000601:surgery*