A Review of Surgical Options to Preserve Fertility in the Treatment of Early Cervical Cancer

Fertility-sparing surgery in the treatment of early cervical cancer is gaining acceptance in the gynecologic oncology community as a safe alternative to radical hysterectomy. In women who desire future child-bearing, more conservative treatments, such as radical trachelectomy with pelvic lymphadenectomy, have led to the achievement of successful pregnancies, and viable deliveries, while maintaining equivalent oncologic outcomes. This review of a total of 984 cases of radical vaginal trachelectomy reported thus far in the literature includes patient and tumor demographics, operative details, recurrence and fertility rates, and obstetrical outcomes. Oncologic outcomes after radical vaginal trachelectomy appears to be equivalent to outcomes after radical hysterectomy in appropriately selected patients, making radical vaginal trachelectomy a viable option for women desiring fertility preservation. Patients require counseling regarding potential obstetrical complications, including preterm pre-labor rupture of membranes and preterm delivery, as well as close oncologic follow-up. Other fertility sparing procedures such as radical abdominal trachelectomy and cone biopsy with lymphadenectomy have also been reported in the literature, but oncologic and fertility data are not yet mature. As more fertility-sparing procedures are performed and additional data is available on risk of recurrence, survival and pregnancy outcomes, further analyses will be possible.