Background: To determine the optimal local treatment modalities in stage IB-IIA adenocarcinoma (AC) of the uterine cervix and assess the impact of tumor size in the clinical outcomes. Methods: Patients with a primary diagnosis of stage IB-IIA cervical AC between 1988 and 2013 were identified using the Surveillance, Epidemiology, and End Results database. Cox regression analyses was performed to analyze the effect of local treatment modalities on cause-specific survival (CSS) and overall survival (OS). Results: A total of 2773 patients were identified. Of these, 1816, 795, and 162 patients received primary surgery, surgery and radiotherapy (RT), and primary RT, respectively. Local treatment modality was the independent prognostic factor for CSS and OS. Patients who received primary surgery had better CSS and OS, especially in patients with tumor size <= 4 cm. However, of those with tumor size >4 cm, patients who underwent primary surgery showed significantly better survival; the survival of patients who underwent surgery and RT was not significantly different from those who underwent primary RT alone. The results were not influenced by the year before (1988-1999) and after (2000-2013) the era of concurrent chemoradiation therapy. Conclusions: Surgery remains the optimal local treatment modality in patients with early stage cervical AC. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.