Introduction/Background*The combination of improved survival and delaying child bearing increases the trend of early cervical cancer diagnosis in women without a fulfilled gestational wish. Fertility preservation surgery (FSS) becomes a necessary treatment option for young women.
The aim of this study is to analyze the impact of tumor size on surgical and oncological outcomes of FSS in early cervical cancer in Spain.
Methodology A multicenter, retrospective cohort study of early cervical cancer (IA2- IB1, FIGO 2009) patients with gestational desire who underwent FSS was carried out at the departments of gynecology of 12 tertiary care hospitals between 01/2005 and 01/2019 throughout Spain. The data were registered in an on-line database. All analyses were performed using STATA 15 statistical software
Result(s)*A total of 111 patients who underwent trachelectomy were included, 82 (73.9%) of them with tumors < 2 cm and 29 (26.1%) of them ≥ 2 cm. Patients’ characteristics were balanced except linfovascular space infiltration (LVSI). All patients were intraoperative node negative. There were no significant differences between groups regarding surgical approach, performance of a posterior cerclage, intraoperative complications or need of posterior hysterectomy.
Median follow-up was 55.7 months in patients group <2 cm tumor and 30.7 months in group ≥2 cm. Eleven recurrences were diagnosed (9.9%), 5 (6.0%) in the <2cms tumor group and 6 (21.4%) in the ≥ 2cms tumor group (p<0.05).
Cox regression was performed to identify different predictor factor for recurrence. Only tumor size (<2cm vs. ≥2cms) was found to be significant among histology, LVSI, previous conization or surgical approach. After adjusting for the rest of the variables, tumor size ≥2cm has a Hazard Ratio of 5.99 (CI 95% 1.01-35.41, p=0.036)
Conclusion*This study shows a real world data of a large number of trachelectomies performed in patients with early cervical cancer after negative lymphnode assessment. Selection criteria should be rigorous especially for patients with tumor ≥ 2 cm due to its worse oncological outcomes. Options may be discussed with the patient to reach a balance between the risk of recurrence and the best fertility results