title: Vaginal Radical Trachelectomy for Early-Stage Cervical Cancer: Increased Recurrence Risk for Adenocarcinoma.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: *Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands; †Department of Gynecological Oncology, UMC Utrecht C9ncer Center, Utrecht, the Netherlands.
authors.forename: Petra L M
authors.initials: PL
authors.lastname: Zusterzeel
authors.forename: Fraukje J M
authors.initials: FJ
authors.lastname: Pol
authors.forename: Maaike
authors.initials: M
authors.lastname: van Ham
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Zweemer
authors.forename: Ruud L M
authors.initials: RL
authors.lastname: Bekkers
authors.forename: Leon F A G
authors.initials: LF
authors.lastname: Massuger
authors.forename: René H M
authors.initials: RH
authors.lastname: Verheijen
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002584:Cervix Uteri / Q000473:pathology*; D005260:Female; D005298:Fertility; D006801:Humans; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies; D000069339:Trachelectomy; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D055815:Young Adult