Fertility‐sparing surgery for early‐stage cervical cancer: A case series study on the efficacy and feasibility of cervical conization followed by pelvic lymphadenectomy

Abstract

Objectives To evaluate the oncologic and obstetric outcomes of cervical conization followed by pelvic lymphadenectomy, which is used as a fertility‐sparing procedure, in reproductive‐aged patients with early‐stage cervical cancer. Methods We performed a retrospective study of patients with stage IA1–IB1 cervical cancer who underwent cervical conization followed by pelvic lymphadenectomy from 2011 to 2020 at Kumamoto University Hospital. Results In total, eight patients underwent conization followed by pelvic lymphadenectomy. The median age of the patients was 33 (range: 28–36) years. Four (50.0%) patients were nulliparous. Seven (87.5%) patients were diagnosed with squamous cell carcinoma (87.5%) and one (12.5%) with adenocarcinoma. Five (62.5%), two (25.0%), and one (12.5%) presented with stage IA1, IA2, and IB1 disease, respectively. Five (62.5%) patients had lymphovascular space invasion (LVSI) based on the assessment of specimens obtained via conization. However, none had lymph node metastasis based on pelvic lymphadenectomy. Regarding long‐term oncologic outcomes, recurrence was not observed at a median follow‐up of 60 (range: 8–107) months. In addition, obstetric outcomes were consistently favorable in terms of achieving pregnancy, preterm delivery, and live birth. During the study period, two patients who actively attempted to conceive had four pregnancies, resulting in full‐term deliveries, and one was on her first trimester of pregnancy. Conclusion Cervical conization combined with pelvic lymphadenectomy represents a feasible conservative management for histologically well‐selected patients with early‐stage cervical cancer. Furthermore, an optimal histopathological evaluation of conization specimens will contribute to decision‐making regarding the use of this fertility‐sparing procedure.

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 ].…”

Oncological and reproductive outcomes of conization combined with pelvic node evaluation in patients with early-stage cervical cancer: a systematic review and meta-analysis

“…After removing 129 duplicate studies, the remaining 389 articles were screened based on titles and abstracts, and obviously ineligible articles were excluded, resulting in a total of 148 articles remaining. After reading the full texts, 17 studies that met the study criteria were eventually included in the analysis (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). The specific search process are detailed in Figure 1.…”

“…Among them, 138 women gave birth to at least one healthy baby. The combined live birth rate was 33.9% (95% CI, 0.261-0.422) (17)(18)(19)(20)(21)(22)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33), and the heterogeneity test result for the included studies was I 2 = 63.2 P < 0.05, indicating high heterogeneity among the included studies (Figure 5-1). Subgroup analysis showed no significant difference among subgroups.…”

“…A total of 415 (72.93%) patients successfully received conization combined with pelvic node evaluation. Furthermore, 183 young women achieved at least one pregnancy, and the combined pregnancy rate was 45.4% (95% CI, 0.34-0.571) (17)(18)(19)(20)(21)(22)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). The heterogeneity test result for the included studies was I 2 = 81.0, P < 0.05 (Figure 4-1), indicating high heterogeneity among the included studies.…”

Association of preoperative conization with recurrences after laparoscopic radical hysterectomy for FIGO 2018 stage IB1 cervical cancer

“…Absence of residual disease in the cervix was of great importance. There were some clinical trials recently which showed that cervical conization with lymph node evaluation may be a feasible conservation management in low-risk cervical cancer [ 29 , 30 ]. Negative surgical margin (> 3 mm) after conization could be oncologic safe even in fertility-sparing patients with stage IB1 (≤ 2 cm).…”