Objectives Cervical cancer (CC) is one of the most common malignant neoplasms and is diagnosed at the youngest middle age among all gynecological cancers. To examine the oncologic and reproductive outcomes of fertility-sparing surgery (FSS) compare to abdominal radical hysterectomy (ARH) in women with early stage CC.

Methods Retrospective data were analyzed from 121 patients with IA2-IB1 and IIA1 CC stages treated at NN Alexandrov National Cancer Centre of Belarus from 2009 to 2018.

Results A total of 83 patients met the FSS inclusion criteria. Thirteen patients were excluded. The rest of 70 patients were selected in FSS study (group 1). Patients were stratified for 3 types of FSS. The results of treatment in group 1 were compared with 51 patients (group 2), whom ARH was performed. Five-year overall survival and 5-year disease-free survival (DFS) were similar between the two groups – 93.1% (SE 4.0%) vs 98.0% (SE 2,0%), p=0.431; and 88,3% (SE 4.2%) vs 92,1% (SE 3.8%), p=0.594, respectively. Similarly, 5-year DFS rate were comparable between groups for all the stages examined. During follow-up 9 pregnancies were achieved in 6 patients. Most pregnancies (6/9, 66.7%) and all deliveries (4) occurred in the ultraminimal FSS subgroup whose patients underwent amputation and pelvic lymphadenectomy.

Conclusions Within this population of early CC patients, equivalent oncologic outcomes have been achieved for FSS group were ultraminimal and minimally invasive approaches were used to compare with ARH group. The fertility-preserving procedure had clear advantages of less invasive access surgery in terms of reproductive outcomes compared to ART.