Fertility-Sparing Options for Early Cervical Cancer: Optimism for Oncologic and Obstetric Outcomes

Purpose of Review

It is well established that in carefully selected patients with early cervical cancer, fertility-sparing procedures are equally safe in terms of recurrence and mortality to the standard treatment with radical hysterectomy. This review highlights the evolution in fertility-sparing management options, with long-term evidence on oncologic and obstetrical outcomes presented.

Recent Findings

The long-term safety of radical vaginal and abdominal trachelectomy is well established. Recently published series also suggest that when patient selection is limited to tumors <2 cm, the oncologic safety for laparoscopic or robotic radical trachelectomy is comparable to the vaginal procedure. Though limited by small numbers and shorter follow-up, favorable outcomes have also been demonstrated for women undergoing conization with tumors <2 cm and neoadjuvant chemotherapy followed by surgical resection for tumors 2–4 cm. Approximately 30 % of women will experience infertility following fertility-sparing treatment, and half of these women can successfully achieve pregnancy with reproductive assistance. Pregnancy can be complicated by premature rupture of membranes, second trimester loss, or preterm delivery. However, most women who achieve pregnancy will reach the third trimester.

Summary

Fertility preservation options are available for women with early stage cervical cancer who wish to preserve their fertility. Radical trachelectomy has equal oncologic safety to radical hysterectomy in selected patients and can be performed by a variety of routes with minimally invasive options providing the best surgical and obstetrical outcomes. Conization has the potential to improve reproductive outcomes even more. For women with tumors 2–4 cm, neoadjuvant chemotherapy is a promising treatment strategy under active investigation.