Fertility-Sparing Trachelectomy With Sentinel Node Mapping in Early-Stage Cervical Cancer: Oncological Safety and Obstetric Outcomes From a Single-Institution Study

Aim

Trachelectomy is a fertility-preserving surgical approach for early-stage cervical cancer. To enhance oncological safety, intraoperative sentinel lymph node (SN) evaluation has been incorporated. This study aimed to evaluate the long-term oncological and obstetric outcomes of trachelectomy with SN biopsy.

Methods

We enrolled 53 patients who underwent trachelectomy with intraoperative SN assessment at Kagoshima University Hospital between 2014 and 2022. The preoperative and intraoperative eligibility criteria were strictly applied. Surgical and obstetric outcomes were evaluated, and recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan–Meier analysis.

Results

Among the 78 candidates, 53 met all criteria and successfully underwent trachelectomy. The 5-year RFS and OS rates were both 98%. Bilateral SNs were detected in 98% of patients, and intraoperative SN biopsy-guided surgical decisions were made. Postoperative complications occurred in 6% of the patients. Of the 19 patients who attempted conception, 10 (53%) became pregnant, leading to 8 live births (five preterm, three term). In vitro fertilization and embryo transfer were used in 60% of the pregnancies. Pregnancy was associated with a high risk of preterm delivery.

Conclusions

Trachelectomy with intraoperative SN biopsy is a feasible and safe treatment option for appropriately selected patients with early-stage cervical cancer. It offers excellent oncological outcomes and acceptable fertility potential. However, the risk of obstetric complications, particularly preterm births, remains high. Structured postoperative and perinatal management is crucial. Further prospective multicenter studies are warranted to validate and refine this approach.