Fertility results and pregnancy outcomes after conservative treatment of cervical cancer: a systematic review of the literature

Abstract

Objectives: To evaluate the fertility results, obstetric outcomes, and the management of infertility in patients submitted to fertility-sparing surgery (FSS) for invasive cervical cancer.

Design: Systematic review.

Setting: Not applicable.

Patient(s): Patients submitted to FSS for invasive cervical cancer (stage IB).

Intervention(s): Five different FSS procedures were studied.

Main outcomes measure(s): Fertility, pregnancy outcomes, and management of infertility.

Result(s): A total of 2,777 patients submitted to FSS and 944 ensuing pregnancies were included in this review. Five different surgical procedures were performed and studied. The overall fertility, live birth, and prematurity rates after these procedures were, respectively, 55%, 70%, and 38%. The pregnancy rate was higher in patients submitted to a vaginal or minimally invasive radical trachelectomy compared with a laparotomic radical trachelectomy. The live birth rate was similar, whatever the FSS procedure. The prematurity rate was significantly lower in patients who had undergone a simple trachelectomy/cone resection and neoadjuvant chemotherapy followed by FSS compared with other conservative surgeries. A majority of second trimester fetal losses and premature deliveries were related to premature rupture of membranes.

Conclusion(s): The choice between the different FSS procedures depends first and foremost on the oncologic characteristics of the tumor. Nevertheless, when several options seem to offer the same oncologic results (for example, stage IB1 disease >2 cm), fertility results should then be taken into consideration to select the best choice acceptable to the patient/couple.

Keywords: Cerclage; conization; conservative treatment; early-stage cervical cancer; fertility; neoadjuvant chemotherapy; preterm delivery; trachelectomy.