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Fertility Sparing Surgery for Cervical Cancer: Practice Points

  • Review Article
  • Published:
Indian Journal of Gynecologic Oncology Aims and scope Submit manuscript

Abstract

Purpose

Cervical cancer is often diagnosed during child-bearing years. The demand to save fertility in these patients is increasing as families are delayed. The challenge is to retain the excellent cure rates for early disease while reaching acceptable pregnancy outcomes. This practical guideline will describe the place of available fertility sparing options and discuss radical trachelectomy in more detail.

Results

Uterus sparing procedures include destruction, LLETZ/LEEP cone, cold knife cone, simple and radical trachelectomy. These surgeries offer increasingly radical removal of the stroma and ligaments with differences between access routes. The ovaries can be saved in all but large adenocarcinoma. Tumour size up to 2 cm limited to the lower cervix and squamous histology type is ideal for safe uterus sparing. Most important for oncological safety are tumour-free margins of 8–10 mm, dissection and assessment of draining nodes and adjuvant treatment when indicated. Pregnancy outcomes are encouraging and probably best when more cervical stroma is spared. Problems include infertility, early and late pregnancy loss and (severe) prematurity. Age, fertility wish, partner availability, pre-existing infertility and immature data all influence published outcomes.

Conclusion

Safe and effective fertility sparing can be offered to most young women with cervical cancer diagnosed in FIGO stage I. Careful attention must be paid to the real need or advantage of fertility saving, the tumour characteristics and the type of surgery that would offer sufficiently radical removal. In addition, the need for nodal removal and for adjuvant therapy must be assessed and not compromised.

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Authors and Affiliations

  1. Gynaecological Oncology Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa

    Greta Dreyer

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Correspondence to Greta Dreyer.

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Dreyer, G. Fertility Sparing Surgery for Cervical Cancer: Practice Points. Indian J Gynecol Oncolog 15, 51 (2017). https://doi.org/10.1007/s40944-017-0144-y

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  • DOI: https://doi.org/10.1007/s40944-017-0144-y

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