Fertility-Sparing Options Versus Abdominal Radical Hysterectomy for Patients with Early Cervical Cancer: Belarus' 10-Year Experience

Objective: The aim of this research was to examine the oncologic and reproductive outcomes of fertility-sparing surgery (FSS) options, compared to abdominal radical hysterectomy (ARH) in women with early cervical cancer (CC). Materials and Methods: Retrospective data were analyzed from 121 patients at IA2-IB1 and IIA1 CC stages treated at the N.N. Alexandrov National Cancer Centre of Belarus, in Minsk, 2009-2018. Results: A total of 83 patients met the FSS inclusion criteria, but 13 more patients were excluded. The remaining 70 patients received FSS (group 1). These patients were stratified for 3 types of FSS: (1) ultraminimal surgery (n = 12); (2) laparoscopic radical trachelectomy (LRT; n = 12) or abdominal radical trachelectomy (ART; n = 40); and (3) neoadjuvant chemotherapy followed by ART (n = 6). The treatment results of group 1 were compared with 51 patients in whom ARH was performed (group 2). The 5-year overall survival rate and 5-year disease-free survival rates were similar between the 2 groups: 93.1% (standard error [SE]: 4.0%) versus 98.0% (SE: 2.0%); p = 0.431; and 88.3% (SE: 4.2%) versus 92,1% (SE: 3.8%), p = 0.594, respectively. During follow-up, 9 pregnancies were achieved in 6 patients. Most of these pregnancies (6/9; 66.7%) and all deliveries (4) occurred in the ultraminimal FSS subgroup, whose patients underwent amputation and pelvic lymphadenectomy. Conclusions: In these patients with early CC, equivalent oncologic outcomes achieved for the FSS group were ultraminimal, and minimally invasive approaches were used to compare with the ARH group. The FSS procedure was clearly less-invasive in terms of reproductive outcomes, compared to ART.