Introduction/Background The aim of this study was to analyze the impact of tumor size >2 cm on oncological outcomes of fertility-sparing surgery (FSS) in early cervical cancer in a Spanish cohort.

Methodology A multicenter, retrospective cohort study of early cervical cancer (stage IA1 with lymphovascular space invasion -IB1 (FIGO 2009) patients with gestational desire who underwent FSS at 12 tertiary departments of gynecology oncology between 01/2005 and 01/2019 throughout Spain.

Results A total of 111 patients were included, 82 (73.9%) with tumors < 2 cm and 29 (26.1%) with tumors 2–4 cm. Patients’ characteristics were balanced except lymphovascular space invasion. All were intraoperative lymphnode negative. Median follow-up was 55.7 and 30.7 months respectively. Eleven recurrences were diagnosed (9.9%), 5 (6.0%) and 6 (21.4%) (p<0.05). 3 years-Progression free survival (PFS) was 95.7% (95%CI 87.3–98.6) and 76.9% (95% CI 55.2–89.0) (p=0.011). Only tumor size (<2 cm vs. 2–4 cms) was found to be significant for recurrence. After adjusting for the rest of the variables, tumor size 2–4 cm showed a Hazard Ratio of 5.99 (CI 95% 1.01–35.41, p=0.036).

Conclusion Tumor size ≥2 cm is the most important negative prognostic factor in this multicenter cohort of patients with early cervical cancer and gestational desire who underwent FSS in Spain.