title: Abdominal radical trachelectomy: Is it safe for IB1 cervical cancer with tumors ≥ 2 cm?
abstract: OBJECTIVE
  As abdominal radical trachelectomy (ART) has become a favored fertility-sparing procedure, the relative contraindication of a tumor ≥ 2 cm in size has been questioned. The aim of the study was to report the surgical and oncological safety of ART for selected patients with cervical cancer ≥ 2 cm in size.
  
  
  METHODS
  We conducted a retrospective review of a prospectively maintained database of patients undergoing ART at our institution from 04/2004 to 01/2013. The largest tumor dimension was determined by physical exam, MRI or final pathology. Clinical and pathological data were tabulated. All patients were followed postoperatively.
  
  
  RESULTS
  Of the 133 patients who underwent planned ART, 62 (46.6%) had tumors ≥ 2 cm in size (2-4 cm). Forty-six patients were documented by exam or MRI, while 16 were documented by pathology reports. The mean age was 30.4 years, and 42 patients (67.7%) were nulliparous. Fifty (80.7%) had squamous carcinoma, 7 (11.3%) had adenocarcinoma and 5 (8%) had adenosquamous carcinoma. Due to frozen-section results, 6 patients (9.7%) underwent an immediate hysterectomy. Due to high-risk features on final pathology, 27 patients (43.5%) were treated with adjuvant chemotherapy (n=20) or chemoradiation (n=7). In total, 55 (88.7%) of 62 patients with a tumor ≥ 2 cm in size preserved their fertility potential. Among these patients, 35 underwent ART without further adjuvant treatment. At a median follow-up of 30.2 months, there were no recurrences.
  
  
  CONCLUSIONS
  Expanding the ART inclusion criteria to cervical cancers ≥ 2 cm in size allows a fertility-sparing procedure in young women who would have otherwise been denied the option with no apparent compromise in oncological outcome. However, this may result in higher rates of conversion to hysterectomy or the need for adjuvant chemotherapy/or chemoradiation.
authors.affiliation: Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, PR China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, PR China.
authors.forename: Jin
authors.initials: J
authors.lastname: Li
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Wu
authors.forename: Xiaoqiu
authors.initials: X
authors.lastname: Li
authors.forename: Xingzhu
authors.initials: X
authors.lastname: Ju
mesh_terms: D000005:Abdomen / Q000601:surgery; D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D018196:Carcinoma, Adenosquamous / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002584:Cervix Uteri / Q000473:pathology; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D003251:Constriction, Pathologic / Q000209:etiology / Q000517:prevention & control; D005260:Female; D059247:Fertility Preservation; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D055815:Young Adult
keywords: Abdominal radical trachelectomy (ART); Cervical cancer; Oncological outcomes; Tumor ≥2cm