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Fertility-Sparing Surgery in Early-Stage Cervical Cancer Patients: Oncologic and Reproductive Outcomes
  1. Antonino Ditto, MD,
  2. Fabio Martinelli, MD,
  3. Giorgio Bogani, MD,
  4. Margherita Fischetti, MD,
  5. Violante Di Donato, MD,
  6. Domenica Lorusso, MD and
  7. Francesco Raspagliesi, MD
  1. Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
  1. Address correspondence and reprint requests to Giorgio Bogni, MD, National Cancer Institute, Via Venezian 1, 20133 Milan, Italy. E-mail: giorgio.bogani@istitutotumori.mi.it; giorgiobogani@yahoo.it.

Abstract

Objective The aim of this study was to evaluate the safety, feasibility, and effectiveness of conservative management of early-stage cervical cancer (eCC) in young women willing to preserve their childbearing potential.

Methods Data of 22 consecutive young women (aged <40 years) undergoing conservative management of eCC were prospectively collected. Conservative management consists of cervical conization plus laparoscopic pelvic lymphadenectomy.

Results Median age was 32.5 years (range, 27–40 years). Twenty-one women (95%) were nulliparous. Histology included adenocarcinoma, squamous cell carcinoma, and adenosquamous carcinoma in 11 (50%), 10 (45%), and 1 (5%) patients, respectively. Six (27%) and 16 patients (73%) were affected by stage IA2 and IB1, respectively. The mean number of pelvic lymph node removed was 26 (SD, 8.6). After primary treatment, 3 patients required radical surgery due to the presence of metastatic nodes detected at the time of diagnostic lymphadenectomy. In addition, 1 patient (5%), after the successful execution of conservative treatment, asked for hysterectomy. After a mean follow-up of 48.8 (SD, 32.8) months, no recurrence was diagnosed among patients undergoing ultraconservative treatment, whereas 2 out of 3 patients with positive pelvic nodes who had radical hysterectomy developed recurrent disease. Considering the whole cohort, 5-year disease-free and overall survival rates were 85.9% and 93.7%, respectively. Looking at reproductive outcomes, 15 of 18 patients (4 patients had hysterectomy) attempted to conceive, and 8 (53%) women had spontaneous pregnancies

Conclusions Conservative management for eCC seems to be associated with long-term oncologic effectiveness, preserving reproductive function. Further large prospective studies are warranted to improve patients’ care.

  • Cervical cancer
  • Conization
  • Conservative surgery
  • Fertility-sparing
  • Lymphadenectomy

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Footnotes

  • The study was conducted in Milan, Italy

  • The authors declare no conflicts of interest.

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