Evaluation of reproductive and oncological outcomes after fertility-sparing surgery in cervical cancer patients with tumor > 2 cm

Background/objectives

We aimed to evaluate the reproductive and oncological outcomes of patients who underwent fertility-sparing surgery (FSS) despite being considered suboptimal candidates due to tumor size > 2 cm with or without lymph node metastasis.

Methods

Between September 2008 and November 2021, 120 patients with early-stage cervical cancer patients who wished to preserve their fertility, were treated in our center. Out of these, 18 patients were not optimal candidates for FSS according to current guidelines. Despite our proposed radical treatment, these patients insisted on having a fertility-sparing treatment. The primary objective was to evaluate the reproductive outcomes including the method of conception, postoperative pregnancy rate, fertility preservation rate, live birth rate, and preterm delivery rate, while the secondary objective was to evaluate 5-year disease-free survival (DFS) and 5-year overall survival (OS).

Results

Out of 18 patients, 5 had lymph node metastasis and 2 of them declined adjuvant chemoradiation. Fertility sparing treatment was successful in 14/18 (77.8 %) patients. Out of the 14, 64.3 % (9/14) tried to conceive, resulting in 2 successful deliveries after in vitro fertilization resulting a live birth rate of 22.2. After a median follow-up of 143.3 months (95 % CI 66–169), the 5-year DFS and OS were 83.3 % (66.1–100) and 93.3 % (80.7–100), respectively.

Conclusions

This study highlights the possibility of FSS in patients with suboptimal tumor characteristics for fertility preservation while providing acceptable oncologic outcomes. We found that classical barriers to FSS can be challenged, balancing fertility preservation and oncological outcomes, and argue for personalized approaches to cervical cancer treatment, respecting patient priorities. Further prospective studies are warranted to establish the efficacy and safety of such approaches.