[Extended trachelectomy relapse: plea for patient involvement in the medical decision]

A series of 96 radical trachelectomies performed between April 1987 and May 2002 at Hospital Edouard Herriot in Lyon is reported. One second cancer (bilateral suprarenal glands cancer) and four recurrences were observed. The retrospective unifactorial analysis demonstrated that the maximal tumoral diameter (2 cm or more) and the depth of infiltration (1 cm or more) were the two only significant factors of risk (p = 0.001 et p = 0.002 respectively). Age less than 30 years and presence of lymphovascular spaces involvement were likely to be factors of risk as well but the level of statistical significance was not reached (p = 0.006). Histotype other than squamous, infiltration of the parametrium and infiltration of the vaginal cuff had no prognosis impact. Adjuvant radiotherapy did not seem to lessen the risk. The chances for recurrence were 19% for the patients affected by a tumor 2 cm or more and 25% for the patients affected by a tumor 2 cm or more with a depth of infiltration 1 cm or more. Should these patients be excluded from the indications of radical trachelectomy? The chances for failure do not seem lower if the radical option is chosen rather than the conservative one. The authors play for a shared decision making.