Advances in fertility-sparing surgery for cervical cancer

Abstract

This article reviews the literature on fertility-sparing surgery in early cervical cancer. The article evaluates selection criteria, preoperative management and the most frequent surgical procedures used for preservation of fertility in cervical cancer. The article also analyzes oncological, fertility and pregnancy results. Oncological outcomes are not statistically different among single groups (vaginal radical trachelectomy, abdominal radical trachelectomy, simple trachelectomy or cone with or without neoadjuvant chemotherapy). Oncological results after fertility-sparing procedures in women with tumors smaller than 2 cm are comparable with women with the same risk factors after radical hysterectomy. Pregnancy following fertility-sparing surgery is associated with a variety of adverse pregnancy outcomes, especially second-trimester loss and preterm delivery. Less radical procedures (simple trachelectomy or cone with or without neoadjuvant chemotherapy) show statistically significant better pregnancy results. The pregnancy rate after abdominal radical trachelectomy was dramatically lower than in women treated with other types of fertility-sparing surgery. In the future, it will be necessary to optimize the technique and management of fertility-sparing surgery in order to attain good oncological results. Pregnancy outcomes should be given high priority. Fertility-sparing surgery is valuable for women who want to preserve their reproductive capability.

Keywords::

• cervical cancer
• fertility-sparing surgery
• radical trachelectomy
• sentinel lymph node
• simple trachelectomy

Financial & competing interests disclosure

This work was supported by grant NS 9914-4. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

^†Women with a tumor larger than 2 cm are potential candidates for neoadjuvant chemotherapy.