TY - JOUR
T1 - Oncologic results of fertility sparing surgery of cervical cancer
T2 - An updated systematic review
AU - Ph, Morice
AU - Maulard, A.
AU - Scherier, S.
AU - Sanson, C.
AU - Zarokian, J.
AU - Zaccarini, F.
AU - Espenel, S.
AU - Pautier, P.
AU - Leary, A.
AU - Genestie, C.
AU - Chargari, C.
AU - Grynberg, M.
AU - Gouy, S.
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Background: Several techniques can be proposed as fertility sparing surgery in young patients treated for cervical cancer but uncertaincies remain concerning their outcomes. Analysis of oncological issues is then the first aim of this review in order to evaluate the best strategy. Results: Data were identified from searches of MEDLINE, Current Contents, PubMed and from references in relevant articles from January 1987 to 15th of September 2021. We carry out an updated systematic review involving 5862 patients initially selected for fertility-sparing surgery in 275 series. Findings: In patients having a stage IB1 disease, recurrence rate/RR in patients undergoing simple conisation/trachelectomy, radical trachelectomy/RT by laparoscopico-vaginal approach, laparotomic or laparoscopic approaches are respectively: 4.1%, 4.7%, 2.4% and 5.2%. In patients having a stage IB2 disease, RR after neoadjuvant chemotherapy or RT by laparotomy are respectively 13.2% and 4.8% (p = .0035). After neoadjuvant treatment a simple cone/trachelectomy was carried out in 91 (30%) patients and a radical one in 210 (70%) cases. But the lowest pregnancy rate is observed in patients undergoing RT by laparotomy (36%). Conclusions: The choice between these treatments should be based above all, on objective oncological data that strike a balance for each procedure between the best chances for cure and the fertility results. In patients having a stage IB1 disease, oncological results are quite similar according to the procedure used. In patients having a stage IB2 disease, RT by open approach has the lowest RR. Anyway the lowest pregnancy rate is observed in patients undergoing RT by laparotomy.
AB - Background: Several techniques can be proposed as fertility sparing surgery in young patients treated for cervical cancer but uncertaincies remain concerning their outcomes. Analysis of oncological issues is then the first aim of this review in order to evaluate the best strategy. Results: Data were identified from searches of MEDLINE, Current Contents, PubMed and from references in relevant articles from January 1987 to 15th of September 2021. We carry out an updated systematic review involving 5862 patients initially selected for fertility-sparing surgery in 275 series. Findings: In patients having a stage IB1 disease, recurrence rate/RR in patients undergoing simple conisation/trachelectomy, radical trachelectomy/RT by laparoscopico-vaginal approach, laparotomic or laparoscopic approaches are respectively: 4.1%, 4.7%, 2.4% and 5.2%. In patients having a stage IB2 disease, RR after neoadjuvant chemotherapy or RT by laparotomy are respectively 13.2% and 4.8% (p = .0035). After neoadjuvant treatment a simple cone/trachelectomy was carried out in 91 (30%) patients and a radical one in 210 (70%) cases. But the lowest pregnancy rate is observed in patients undergoing RT by laparotomy (36%). Conclusions: The choice between these treatments should be based above all, on objective oncological data that strike a balance for each procedure between the best chances for cure and the fertility results. In patients having a stage IB1 disease, oncological results are quite similar according to the procedure used. In patients having a stage IB2 disease, RT by open approach has the lowest RR. Anyway the lowest pregnancy rate is observed in patients undergoing RT by laparotomy.
KW - Conisation
KW - Conservative treatment
KW - Early-stage cervical cancer
KW - Fertility
KW - Neoadjuvant chemotherapy
KW - Prognostic factor
KW - Radical trachelectomy
KW - Recurrence
KW - Trachelectomy
UR - http://www.scopus.com/inward/record.url?scp=85125506833&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2022.01.023
DO - 10.1016/j.ygyno.2022.01.023
M3 - Review article
C2 - 35241291
AN - SCOPUS:85125506833
SN - 0090-8258
VL - 165
SP - 169
EP - 183
JO - Gynecologic Oncology
JF - Gynecologic Oncology
IS - 1
ER -