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Oral Sessions
04. Fertility/Pregnancy
#556 Reproductive outcomes after fertility-sparing surgery for cervical cancer – results of the fertiss study
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  1. Jiri Slama1,
  2. Ingo Runnebaum2,
  3. Giovanni Scambia3,
  4. Martina Angeles Fite4,
  5. Kiarash Bahrehmand5,
  6. Stefan Kommoss6,
  7. Fabrice Narducci7,
  8. Olga Matylevich8,
  9. Jessica Holly9,
  10. Fabio Martinelli10,
  11. Meriem Koual11,
  12. Olena Samokhvalova12,
  13. Ahmed El-Balat13,
  14. Giacomo Corrado3,
  15. Mihai Emil Capîlna14,
  16. Willibald Schröder15,
  17. Zoltán Novàk5,
  18. Alexander Shushkevich8,
  19. Lenka Fricova16 and
  20. David Cibula16
  1. 1Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, CEEGOG, Prague, Czech Republic
  2. 2Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller University, AGO Study Group, Jena, Germany
  3. 3Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart Rome, MITO, Rome, Italy
  4. 4Claudius Regaud Institute – University Cancer Institute, GINECO, Toulouse, France
  5. 5Department of Gynecology, Hungarian National Institute of Oncology, CEEGOG, Budapest, Hungary
  6. 6Tuebingen University Hospital, Department of Women’s Health, AGO Study Group, Tuebingen, Germany
  7. 7Department of Gynecology Oncology, Oscar Lambret Cancer Center, GINECO, Lille, France
  8. 8Gynecologic Oncology Department, N.N. Alexandrov National Cancer Centre of Belarus, CEEGOG, Minsk, Belarus
  9. 9Department of Gynecological Oncology, Evangelical Clinic Essen Mitte, Germany, AGO Study Group, Essen, Germany
  10. 10Fondazione IRCCS Istituto Nazionale Tumori – Milan, MITO, Milan, Italy
  11. 11Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, GINECO, Paris, France
  12. 12Department of Gynecologic Oncology, National Cancer Institute, CEEGOG, Kyiv, Ukraine
  13. 13University Clinic Frankfurt, Goethe-University, Department of Gynecology and Obstetrics, Frankfurt am Main, Germany; Spital Uster, Women’s Hospital, AGO Study Group, Uster, Switzerland
  14. 14First Obstetrics and Gynecology Clinic,, Târgu Mure?, Romania
  15. 15Gynaekologicum Bremen, AGO Study Group, Bremen, Germany
  16. 16Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic, CEEGOG, Prague, Czech Republic

Abstract

Introduction/Background The goal of fertility-sparing treatment (FST) for patients with cervical cancer is to achieve comparable oncologic outcomes to those after radical treatment while maximizing reproductive outcomes, which include the ability to conceive and minimizing the risk of preterm birth.

Methodology Patients from the international multicentre retrospective FERTISS study, which included women treated with any type of FST, were analysed for information on timing of FST in relation to pregnancy, attempts to conceive, mode of conception, prophylactic procedures to reduce the risk of severe prematurity, rate of pregnancy failure, overall duration of pregnancy and mode of termination.

Results Of the 733 patients treated at 44 centres in 13 countries, only half (49.7%) attempted to become pregnant during follow-up (median 72 months). Unsuccessful attempts were recorded in 27.0% (198/733) of patients, while 22.6% (166/733) were successful. Of these patients, 63.2% (122/193) underwent non-radical surgery and 25.7% (44/171) underwent radical trachelectomy (p < 0.001). Data from 124 patients (74.7%) were available for detailed analysis. A total of 91.7% (111/124) patients became pregnant naturally. The abortion rate in the first pregnancy did not differ between patients after radical and non-radical procedures. There was no difference in delivery success rates between patients after non-radical and radical FST (86% vs. 83%, p=0.77). Preterm delivery (<38 weeks gestation) occurred more frequently in patients after radical than non-radical procedures (76.5% vs. 57.7%, p=0.15). Almost all patients (97.3%) with ultrasound cervicometry delivered, in contrast to women without cervicometry (30.6%), (p<0.001).

View this table:
Abstract #556 Table 1

Characteristic of cohort

Conclusion Half of the patients did not attempt pregnancy at all after FST. Patients who underwent non-radical surgery had higher pregnancy rates. Most women who became pregnant delivered a viable fetus, but women who underwent radical trachelectomy had a higher rate of preterm births in the severe prematurity range. Ultrasound cervicometry showed a significant effect on the prevention of preterm birth.

https://doi.org/10.1136/ijgc-2023-ESGO.21

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