Vaginal Radical Trachelectomy for early XXXX . Results of the Danish National Single Center Strategy.

@entity5 @entity1 @entity3846
OBJECTIVE: To present and evaluate an unselected national single center strategy with fertility preserving trachelectomy in @entity5 . In 2003 nationwide single-center referral of @entity1 for trachelectomies was agreed upon between all Danish departments performing @entity5 surgery with the purpose of increasing volume, to increase surgical safety and facilitate follow-up. METHODS: Prospective data were recorded in the Danish Gynecological Cancer Database of all Vaginal Radical Trachelectomies (VRT) performed in Denmark between 2002 and 2013. Oncologic, fertility and obstetrical outcomes of 120 unselected consecutive VRTs were assessed. To obtain complete follow-up about fertility treatment, pregnancy and obstetric outcome the @entity1 filled out an electronic questionnaire. Median follow-up: 55.7 months. RESULTS: 85.8% of the @entity1 had stage @entity3846 disease, 68.3% squamous cell carcinomas, 30.0% adenocarcinomas and 1.7% adenosquamous carcinomas. Six recurrences (5.1%) and 2 deaths (1.7%) occurred. Four @entity1 with adenocarcinomas (10.5%) had recurrences, compared to two @entity1 with squamous cell carcinomas (2.5%). Seventy-two @entity1 (60.0%) desired to conceive and 55 @entity1 obtained a total of 77 pregnancies. Of the 72 @entity1 40 were referred to fertility treatment. First and second trimester miscarriage rates were 21.6% and 2.7%, respectively. A total of 53 @entity1 were born of which 41 were delivered after gestational week 34. CONCLUSION: This unselected national single center referral study confirms the oncological safety of Vaginal Radical Trachelectomy. The complete follow-up regarding reproductive data, reveals a surprisingly extensive need of fertility treatment and due to the rate of prematurity, these pregnancies must be regarded as high-risk pregnancies.
