Oncological outcomes after fertility-sparing surgery for cervical cancer: a systematic review

Fertility preservation in young patients with cervical cancer is suitable only for patients with good prognostic factors and disease amenable to surgery without adjuvant therapy. Consequently, it is only offered to patients with early-stage disease (stage IB tumours <4 cm), negative nodes, and non-aggressive histological subtypes. To determine whether fertility preservation is suitable, the first step is pelvic-node dissection to establish nodal spread. Tumour size (<= 2 cm vs >2 cm) and lymphovascular space invasion status are two main factors to determine the best fertility-sparing surgical technique. In this systematic Review, we assess six different techniques that are available to preserve fertility (Dargent's procedure, simple trachelectomy or cone resection, neoadjuvant chemotherapy with conservative surgery, and laparotomic, laparoscopic and robot-assisted abdominal radical trachelectomy). The choice between the six different fertility preservation techniques should be based on the experience of the team, discussion with the patient or couple, and, above all, objective oncological data to balance the best chance for cure with optimum fertility results for each procedure.