Reproductive and oncologic outcomes after fertility-sparing surgery for early stage cervical cancer: a systematic review

Vaginal radical trachelectomy has the highest clinical pregnancy rate and minimally invasive approaches to fertility-sparing surgery have equivalent oncologic outcomes compared to an abdominal approach.
Reproductive and oncologic outcomes after fertility-sparing surgery for early stage cervical cancer: a systematic review
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Volume 113, Issue 4, Pages 685–703

Authors:

Camran Nezhat, M.D., Robert A. Roman, M.D., Anupama Rambhatla, M.D., Farr Nezhat, M.D.

Abstract:

This review sought to evaluate the current literature on reproductive and oncologic outcomes after fertility-sparing surgery for early stage cervical cancer (stage IA1–IB1) including cold-knife conization/simple trachelectomy, vaginal radical trachelectomy, abdominal radical trachelectomy, and laparoscopic radical trachelectomy with or without robotic assistance. A systematic review using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist to evaluate the current literature on fertility-sparing surgery for early stage cervical cancer and its subsequent clinical pregnancy rate, reproductive outcomes, and cancer recurrence was performed. Sixty-five studies were included encompassing 3,044 patients who underwent fertility-sparing surgery, including 1,047 pregnancies with reported reproductive outcomes. The mean clinical pregnancy rate of patients trying to conceive was 55.4%, with the highest clinical pregnancy rate after vaginal radical trachelectomy (67.5%). The mean live-birth rate was 67.9% in our study. Twenty percent of pregnancies after fertility-sparing surgery required assisted reproductive technology. The mean cancer recurrence rate was 3.2%, and the cancer death rate was 0.6% after a median follow-up period of 39.7 months with no statistically significant difference across surgical approaches. Fertility-sparing surgery is a reasonable alternative to traditional radical hysterectomy for early-stage cervical cancer in women desiring fertility preservation. Vaginal radical trachelectomy had the highest clinical pregnancy rate, and minimally invasive approaches to fertility-sparing surgery had equivalent oncologic outcomes compared with an abdominal approach. The results of our study allow for appropriate patient counseling preoperatively and highlight the importance of a multidisciplinary approach to achieve the best outcomes for each patient.



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Comments

Go to the profile of Joyce Dillon Reinecke
over 2 years ago

I thought this was such a comprehensive overview. Really important information to share out to the cervical cancer community. Thank you, Joyce Reinecke, Alliance for Fertility Preservation

Go to the profile of Chin-Jui WU
over 2 years ago

My article was cited No. 50 in the review. It's my honor to contribute my data to the great comprehensive review. But I found my follow-up interval was mistaken for "months", which is "years" originally. I wish there'll be a correction. Thank you!