Fertility-sparing treatment for early-stage cervical cancer

Abstract

Fertility preservation is of paramount importance for young women that are diagnosed with early-stage cervical cancer. Women with stage IA1 disease can be treated with conization. Radical trachelectomy has been developed as a surgical method for preserving reproductive function, and the radical trachelectomy procedure has evolved significantly over the last 25 years. The candidates for radical trach- electomy include women of reproductive age with early-stage disease (stage IA2 or IB1) who do not possess any risk factors for recurrence (i.e., a lesion size of >2 cm or lymph node metastasis). Lymphovascular space invasion within the tumor is a risk factor for lymph node recurrence, but is not a contraindication for fertility-sparing surgery in cases in which it is the only risk factor present. Recently, neoadjuvant chemotherapy followed by fertility-preserving surgery has been proposed as an option for patients with larger lesions. Pregnancy after radical trachelectomy is associated with an increased risk of obstetric complications, including preterm delivery, infection, and preterm premature rupture of membranes. However, there are no effective interventions for preventing these complications.