title: Nerve-sparing radical abdominal trachelectomy versus nerve-sparing radical hysterectomy in early-stage (FIGO IA2-IB) cervical cancer: a comparative study on feasibility and outcome.
abstract: OBJECTIVE
  Standard treatment in early-stage cervical cancer is a radical hysterectomy (RH) with pelvic lymphadenectomy. In women who wish to preserve fertility radical vaginal trachelectomy has been proposed; however, this is not feasible in larger tumors, and nerve-sparing surgery is not possible. Nerve-sparing radical abdominal trachelectomy (NSRAT) overcomes these disadvantages.
  
  
  METHODS
  Case-control study of women with early-stage cervical cancer (International Federation of Gynecology and Obstetrics IA2-IB) submitted to NSRAT from 2000 until 2011. Women submitted to nerve-sparing RH with early-stage cervical cancer were included as control subjects.
  
  
  RESULTS
  Twenty-eight patients and 77 control subjects were included. Neoadjuvant chemotherapy was administered in 3 women before NSRAT because the linear extension was or exceeded 40 mm. Local recurrence rate was 3.6% (95% confidence interval [CI], 0.00-10.6) in the NSRAT group compared with 7.8% (95% CI, 1.7-13.9) in the control group (P = 0.44). No significant difference was found between both groups regarding disease-free survival and survival. The overall pregnancy rate was 52.9% (95% CI, 28.7%-77.2%). The mean follow-up was 47.3 months (range, 6-122 months) for NSRAT and 51.8 months (11-129.6 months) for nerve-sparing RH.
  
  
  CONCLUSIONS
  Nerve-sparing radical abdominal trachelectomy seems safe and effective in women with early-stage cervical cancer who wish to preserve fertility. Respective women should be informed about this treatment option, especially if the tumor is too large for radical vaginal trachelectomy.
authors.affiliation: Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Mignon Dingena Johanna Maria
authors.initials: MD
authors.lastname: van Gent
authors.forename: Lukas Wesley
authors.initials: LW
authors.lastname: van den Haak
authors.forename: Katja Nicolien
authors.initials: KN
authors.lastname: Gaarenstroom
authors.forename: Alexander A W
authors.initials: AA
authors.lastname: Peters
authors.forename: Mariette Inie Elisabeth
authors.initials: MI
authors.lastname: van Poelgeest
authors.forename: Johanes Baptist Maria Zacharias
authors.initials: JB
authors.lastname: Trimbos
authors.forename: Cor Doede
authors.initials: CD
authors.lastname: de Kroon
mesh_terms: D000005:Abdomen / Q000473:pathology / Q000601:surgery*; D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D018196:Carcinoma, Adenosquamous / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000473:pathology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D059247:Fertility Preservation; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D009420:Nervous System; D059351:Organ Sparing Treatments / Q000379:methods*; D011247:Pregnancy; D011379:Prognosis; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult