Twenty years of experience with less radical fertility-sparing surgery in early-stage cervical cancer: Oncological outcomes

Hruda, Martin; Robová, Helena; Rob, Lukáš; Halaška, Michael; Drozenová, Jana; Pichlík, Tomáš; Malíková, Hana

doi:10.1016/j.ygyno.2021.07.031

Cited by 10 publications

(3 citation statements)

References 23 publications

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“…Previous reviews have evaluated the outcomes for fertility-preserving surgical management in cervical cancer. For low-risk tumors up to 2 cm, conization or trachelectomy through vaginal, abdominal, or minimally invasive surgery has shown favorable results 2 4 32 33. Recently, a prospective trial of 100 patients evaluating less radical surgery for low-risk cervical cancer included 42 women with squamous cell carcinoma and adenocarcinoma who underwent conization with negative lymph node evaluation for fertility preservation 32.…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 35% of patients diagnosed are <45 years of age and, due to a delay in childbearing, a growing number of women of reproductive age desire fertility-sparing treatment 2 3. Fertility preservation may be considered in select cases through conization, simple trachelectomy, or radical trachelectomy depending on the risk factors for International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IA1 + lymphovascular space invasion, IA2, and IB1 stages,2 4 and the lymph node evaluation may be performed through systematic pelvic lymph node dissection or in some cases by sentinel lymph node (SLN) detection, or a combination of both procedures 5 6. For tumors of 2–4 cm there is the option of upfront abdominal radical trachelectomy7–9 or the use of neo-adjuvant chemotherapy followed by conization or trachelectomy according to the response 10–12.…”

Section: Introductionmentioning

confidence: 99%

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Fertility-sparing surgery after neo-adjuvant chemotherapy in women with cervical cancer larger than 4 cm: a systematic review

Viveros‐Carreño

Rodriguez

Pereira

et al. 2022

International Journal of Gynecological Cancer

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ObjectiveThe objective of this systematic review was to assess the oncologic and fertility outcomes of patients with cervix-confined cancer >4 cm who underwent neo-adjuvant chemotherapy followed by fertility-sparing surgery.MethodsThis study was registered in PROSPERO (registration number CRD42021254816). PubMed/MEDLINE, ClinicalTrials, EMBASE, Cochrane Central Register of Controlled Trials, SCOPUS, and OVID databases were searched from inception to July 2021. The included patients were those with cancer confined to the cervix and tumor diameter >4 cm (International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IB3) with squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma who underwent intra-venous neo-adjuvant chemotherapy followed by successful fertility-sparing surgery.ResultsThe initial search identified 2990 articles. A total of 40 patients from 11 studies had attempted fertility preservation surgery (conization, simple or radical trachelectomy) and in 26 patients (65%) it was successful. All patients received platinum-based chemotherapy. A complete pathological response occurred in 56% of patients and two patients (7.7%) had a recurrence. The 4.5-year disease-free survival was 92.3% and the 4.5-year overall survival rate was 100%. Of six patients who tried to conceive, four (67%) achieved at least one pregnancy and three of the five pregnancies (60%) were pre-term deliveries (all after radical trachelectomy). All patients with recurrence received cisplatin and ifosfamide instead of cisplatin and paclitaxel, underwent non-radical surgery, and had residual disease in the final specimen.ConclusionsEvidence for fertility-sparing surgery after neo-adjuvant chemotherapy in patients with cervical cancer and tumors >4 cm is limited, and this approach should be considered as an experimental intervention. As the use of non-radical surgery could be a risk factor, if neo-adjuvant chemotherapy is used, patients should undergo fertility-sparing radical surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fertility-sparing surgery after neo-adjuvant chemotherapy in women with cervical cancer larger than 4 cm: a systematic review

Viveros‐Carreño

Rodriguez

Pereira

et al. 2022

International Journal of Gynecological Cancer

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“…A single-centre study conducted in Germany reported favourable fertility and oncologic outcomes among 16 patients who underwent local excision for early-stage cervical cancer during the 8-year follow-up period, with nine pregnancies and mostly spontaneous conceptions, and no recurrence of cervical cancer within the investigated time range 13 . Similarly, a study involving 91 Czech women showed that in patients with cervical cancer with a maximum diameter of less than 2 cm and infiltration of less than half of the interstitial cervical space, the recurrence rate was an acceptable 5.0% with no mortality in patients who underwent local excision over 20 years 14 . Despite the findings of these meta-analyses and case-control studies, a lack of large studies comparing local excision and hysterectomy for early-stage cervical cancer persists.…”

Section: Introductionmentioning

confidence: 94%

Local excision as a viable alternative to hysterectomy for early-stage cervical cancer in women of reproductive age: a population-based cohort study

Chen

Zheng

et al. 2023

International Journal of Surgery

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Background: Local excision as the main alternative for fertility-sparing surgery (FSS) has been widely used in patients with early-stage cervical cancer to achieve fertility preservation, but its safety and practicability are still questioned. Therefore, The authors evaluated the current application of local excision in early-stage cervical cancer with this population-based study and compared its efficacy with hysterectomy. Materials and methods: Women diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage I cervical cancer at childbearing age (18–49 years) recorded in the Surveillance, Epidemiology and End Results (SEER) database from 2000 to 2017 were included. Overall survival (OS) and disease-specific survival (DSS) rates were compared between local excision and hysterectomy. Results: A total of 18 519 patients of reproductive age with cervical cancer were included, and 2268 deaths were observed. 17.0% of patients underwent FSS via local excision, and 70.1% underwent hysterectomy. Among patients younger than 39 years, OS and DSS of local excision were comparable to those of hysterectomy, whereas, in patients older than 40 years, OS and DSS of local excision were significantly worse than those of hysterectomy. In addition, OS and DSS of local excision were similar to hysterectomy in patients with stage IA cervical cancer, but OS and DSS were inferior to hysterectomy in patients with stage IB cervical cancer who underwent local excision. Conclusion: For patients without fertility requirements, hysterectomy remains the best therapeutic option. However, for patients under 40 years of age diagnosed with stage IA cervical cancer, FSS via local excision is a viable option that can achieve a well-balanced outcome between tumour control and fertility preservation.

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Analysis of risk factors for recurrence in cervical cancer patients after fertility-sparing treatment: The FERTIlity Sparing Surgery retrospective multicenter study

Sláma¹,

Runnebaum²,

Scambia³

et al. 2023

American Journal of Obstetrics and Gynecology

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Twenty years of experience with less radical fertility-sparing surgery in early-stage cervical cancer: Oncological outcomes

Cited by 10 publications

References 23 publications

Fertility-sparing surgery after neo-adjuvant chemotherapy in women with cervical cancer larger than 4 cm: a systematic review

Fertility-sparing surgery after neo-adjuvant chemotherapy in women with cervical cancer larger than 4 cm: a systematic review

Local excision as a viable alternative to hysterectomy for early-stage cervical cancer in women of reproductive age: a population-based cohort study

Analysis of risk factors for recurrence in cervical cancer patients after fertility-sparing treatment: The FERTIlity Sparing Surgery retrospective multicenter study

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