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395 Current practices of fertility sparing surgery and cerclage placement; a survey of experts worldwide
  1. Anke Smits1,
  2. Janneke Wolswinkel1,
  3. Mieke Ten Eikelder1 and
  4. Petra Zusterzeel2
  1. 1Radboud University Medical Center, Nijmegen, The Netherlands
  2. 2Department of Obstetrics and Gynecology, Nijmegen, The Netherlands


Introduction/Background Fertility-sparing surgery (FSS) is offered as part of standard practise for early stage cervical cancer. However, definitive guidelines on surgical procedures are lacking, with significant variation in clinical practice, and changes in practice over time. We performed a survey among experts worldwide to assess the current practice of FFS in tumors ≤ 2cm and > 2cm and the practice of additional cerclage placement.

Methodology This was a cross-sectional survey study performed among trachelectomy expert centres worldwide between May - July 2023. Eligible expert centres were identified based on literature, international workgroups and conferences, and were approached through an email invitation. The survey consisted of 27 questions including questions assessing current and previous practices of trachelectomy and cerclage placement.

Results In total, 21 (36.2%) consultants from different gynaecological oncology centres completed the survey. Assessment of cervical length was mainly performed using MRI. The majority (86%) still preferred a radical trachelectomy for tumors ≤ 2cm, through vaginal (40.9%) abdominal (27.3%) or robot-assisted (13.6%) approach. For tumors > 2cm, the majority 47.6% used of neoadjuvant chemotherapy prior to a trachelectomy, followed by simple trachelectomy (9.0%), radical vaginal (4.3%) or abdominal trachelectomy (9.5%). Six respondents (28.6%) performed an abdominal radical trachelectomy without chemotherapy for these tumours. Respondents stated that over time, they moved towards less radical surgery and some abandoned a minimal invasive approach. Almost all centres (90.5%) still placed a cerclage immediately after trachelectomy regarding cervical insufficiency. Two French centres abandoned cerclage placement, with no observed negative effects on obstetric outcomes.

Conclusion Recent trials have influenced the practice in FSS, with still significant variation among centers worldwide, underlining the need for clear guidelines and randomised studies.

Disclosures None to disclose.

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