Oncologic and obstetric outcomes after simple conization for fertility-sparing surgery in FIGO 2018 stage IB1 cervical cancer

Abstract

ObjectiveConization/simple trachelectomy is feasible in patients with early-stage cervical cancer. Retrospective data suggest that conization with negative lymph nodes could be a safe option for these patients. This study aims to provide oncologic and obstetric outcomes of a large series of patients with 2018 International Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical cancer managed by conization.MethodsPatients with early cervical cancer and a desire to preserve fertility who underwent conization and pelvic lymphadenectomy from January 1993 to December 2019 in two Italian centers were included. Inclusion criteria were: age >18 years and ≤45 years, 2018 FIGO stage IB1, no prior irradiation or chemotherapy, absence of pre-operative radiologic evidence of nodal metastases, a strong desire to preserve fertility, and absence of concomitant malignancies. We excluded patients with confirmed infertility, neuroendocrine tumor, clear cell or mucinous carcinoma.ResultsA total of 42 patients were included. The median age was 32 years (range 19–44) and median tumor size was 11 mm (range 8–20). Squamous cell carcinoma was found in 27 (64.3%). Grade 3 tumor was present in 7 (16.7%) patients and lymphovascular space involvement was detected in 15 (35.7%). At a median follow-up of 54 months (range 1–185), all patients were alive without evidence of disease. In the entire series three patients experienced recurrence resulting in an overall recurrence rate of 7.1%. All the recurrences occurred in the pelvis (2 in the cervix and 1 in the lymph nodes), resulting in a 3-year disease-free survival of 91.6%. Twenty-two (52%) patients tried to conceive; 18 pregnancies occurred in 17 patients and 12 live births were reported (6 pre-term and 6 term pregnancies). Two miscarriages were recorded, one first trimester and one second trimester fetal loss.ConclusionsOur study showed that conization is feasible for the conservative management of women with stage IB1 cervical cancer desiring fertility. Oncologic outcomes appear favorable in this series of patients. Future prospective studies will hopefully provide further insight into this important question.

Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Cervical Cancer

“…2 In our study, the odds of preterm birth before 37 weeks of gestation were approximately double among patients with cervical cancer compared with those in the control groups, consistent with prior studies. 6,10,[32][33][34] Our study design allows for more reliable estimates compared with case series with few pregnancies and limited obstetric outcomes, [11][12][13][14][15][16][17][18] systematic reviews that pool these same uncontrolled studies, 7,9,10 and population-based studies that used International Classification of Diseases codes to identify cancer diagnoses. 20 Our findings are consistent with those of a database study by Hartnett and colleagues 8 that demonstrated a 28% rate of preterm birth before 37 weeks of gestation, which translated to more than double the risk of preterm birth compared with the control groups.…”

“…6,7 Observational studies have demonstrated that more than a third of cervical cancer survivors who ultimately conceive will deliver prematurely. [7][8][9][10] However, the available data are limited because they are derived from case series [11][12][13][14][15][16][17][18] and systematic reviews of case series with few pregnancies. 7,9,10 Population-based studies have included more pregnancies after cervical cancer surgery but often lack a rigorous definition of pregnancy timing related to cancer diagnosis, 8,19 match control group participants to case group participants on few demographic variables, 8,19 or summarize outcomes from patients with different types of reproductive cancers.…”

Reproductive and Obstetric Outcomes after Fertility-Sparing Treatments for Cervical Cancer: Current Approach and Future Directions

“…Multiple studies investigated the results of fertility-sparing treatment in the early stages of cervical cancer and considered the subsequent pregnancies and their outcomes [ 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 ]. Anderson et al (2018) studied the pregnancy rate in women with a history of previous cancer and compared it to that of women from the general population ( Table 1 ) [ 57 ].…”

Fertility‐sparing and minimally invasive surgery for early‐stage cervical cancer

“…26 Complication rates and risk of postoperative cervical stenosis (7%) are lower than with VRT and ART, and recurrence rates are concordant with prior retrospective data (3.5%). [27][28][29][30]…”