Cervical Adenocarcinoma: What's Special About the Long‐Term Reproductive and Oncological Outcomes of Fertility‐Sparing Radical Trachelectomy in It?

TL;DR

This study examines the long-term reproductive and cancer outcomes of fertility-preserving surgery in women with cervical adenocarcinoma.

Contribution

The paper provides novel insights into the effectiveness and risks of radical trachelectomy for cervical adenocarcinoma patients seeking fertility.

Findings

A 36.67% pregnancy success rate was observed among patients attempting to conceive after radical trachelectomy.

Seven patients (13.73%) experienced cancer recurrence, with most relapses occurring beyond the residual cervix.

Adjuvant chemotherapy improved cancer recurrence and death rates in patients with risk factors.

Abstract

To present reproductive and oncological outcomes of radical trachelectomy (RT) in patients with cervical adenocarcinomas (AC).

This retrospective study included 51 patients with cervical AC who underwent RT at Peking Union Medical Hospital from January 1, 2005 to June 1, 2023.

Five patients (9.8%) experienced cervical stenosis following RT, which likely occurred in cases of abdominal RT (50%) and virginal prophylactic cerclage (33.33%) and those without copper T intrauterine devices during RT (20%). In total, 30 patients (58.82%) attempted to conceive, and 11 (36.67%) succeeded. Five patients (45.45%) achieved pregnancy with fertility assistance. The mean surgery–pregnancy interval was 27 months (range, 17–118). Two preterm and two full‐term births were achieved. With a median follow‐up of 50 months (range, 7–238), seven patients (13.73%) experienced recurrence and three (5.88%) died. Six of seven patients relapsed beyond the residual cervix. The cancer recurrence rate (CRR) was 5.88% for patients with pre‐cervical conization and 17.65% for those with biopsy (p = 0.250); 11.63% had human papillomavirus‐associated (HPVA) disease and 25% had non‐HPVA (NHPVA) (p = 0.313). The cancer death rate (CDR) was 4.65% with HPVA and 12.50% with NHPVA (p = 0.386); 13.63% had the endogenous type and 0 had the exogenous type (p = 0.04). Chemotherapy in patients with risk factors resulted in better CRR and CDR than in those without (5.88% vs. 17.65%, 0% vs. 8.82%). The cumulative 5‐year recurrence‐free survival (RFS) and overall survival rates were 82.03% and 94.39%, respectively.

RT in patients with AC led to an acceptable pregnancy rate but a higher CRR and lower 5‐year RFS. Careful patient selection for RT, combined with adjuvant chemotherapy when indicated, is crucial to optimize the balance between reproductive and oncological outcomes in AC.