Fertility-sparing surgery in early-stage cervical cancer patients: oncologic and reproductive outcomes

Objective: The aim of this study was to evaluate the safety, feasibility, and effectiveness of conservative management of early-stage cervical cancer (eCC) in young women willing to preserve their childbearing potential. Methods: Data of 22 consecutive young women (aged <40 years) undergoing conservative management of eCC were prospectively collected. Conservative management consists of cervical conization plus laparoscopic pelvic lymphadenectomy. Results: Median age was 32.5 years (range, 27-40 years). Twenty-one women (95%) were nulliparous. Histology included adenocarcinoma, squamous cell carcinoma, and adenosquamous carcinoma in 11 (50%), 10 (45%), and 1 (5%) patients, respectively. Six (27%) and 16 patients (73%) were affected by stage IA2 and IB1, respectively. The mean number of pelvic lymph node removed was 26 (SD, 8.6). After primary treatment, 3 patients required radical surgery due to the presence of metastatic nodes detected at the time of diagnostic lymphadenectomy. In addition, 1 patient (5%), after the successful execution of conservative treatment, asked for hysterectomy. After a mean follow-up of 48.8 (SD, 32.8) months, no recurrence was diagnosed among patients undergoing ultraconservative treatment, whereas 2 out of 3 patients with positive pelvic nodes who had radical hysterectomy developed recurrent disease. Considering the whole cohort, 5-year disease-free and overall survival rates were 85.9% and 93.7%, respectively. Looking at reproductive outcomes, 15 of 18 patients (4 patients had hysterectomy) attempted to conceive, and 8 (53%) women had spontaneous pregnancies Conclusions: Conservative management for eCC seems to be associated with long-term oncologic effectiveness, preserving reproductive function. Further large prospective studies are warranted to improve patients' care.