Abstract
Objectives
To evaluate the oncologic and obstetric outcomes of patients with low-risk cervical
cancer who underwent conization and lymphatic evaluation to preserve fertility.
Methods
Data were collected retrospectively from September 2013 to February 2021. Eligibility
criteria included Women with cervical cancer (aged <45 years) who underwent fertility
preservation treatment, [stage IA1 with positive lymphovascular space invasion (LVSI),
stage IA2, or stage IB1 (≤2 cm) with less <10 mm cervical stromal invasion, according
to the International Federaltion of Gynecology and Obstetrics (FIGO) 2018 staging
system] aged ≤45 years who wished to preserve their fertility were included in this
study. All patients were treated with cervical conization(s) and laparoscopic lymph
node evaluation [pelvic lymphadenectomy and/or sentinel lymph node (SLN) mapping].
Oncologic and obstetric outcomes were evaluated.
Results
Overall, 31 patients met the inclusion criteria; 15 (48.3%) women were nulliparous.
There were 8 IA1LVSI+ (25.8%), 11 IA2 (35.4%) and 12 IB1 (31.7%) tumours, according
to 2018 FIGO stage classification. Most patients had squamous cell carcinoma (77.4%).
Lymphovascular space involvement was found in thirteen patients (41.9%). Reconization
was performed in 17 (54.8%) patients, of which 6(35.2%) were done due to compromised
margins, 4(23.5%) for margins under than 3 mm, 3(17.6%) for unreported or coagulated
margins and 4(23.5%) because previous conization was done in another institution and
we could not obtain the paraffin blocks for pathology review. Twenty patients had
MRI and eleven CT scan. Nine (30%) patients had a complete bilateral pelvic lymph
node dissection, 9 (26.6%) had SLN mapping with pelvic lymphadenectomy, and 13 (43.3%)
had SLN mapping alone after bilateral SLN identification at surgery. After a median
follow-up of 41.4 months (range 2–90 months), no recurrences have been detected. In
terms of obstetrial outcome, 11 patients attempted pregnancy and 9 became pregnant.
First-trimester miscarriage occurred in one patient. Five patients delivered at term
by caesarean section, one of them requiring hysterectomy at the time of delivery.
Pathology did not show residual disease. Two patients had a vaginal delivery at 38 weeks.
One pregnancy is still ongoing.
Conclusion
Cervical conization with lymph node assessment by SLN mapping/lymphadenectomy is an
oncologic safe procedure in patients with low-risk cervical cancer.
Keywords
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Article info
Publication history
Published online: September 17, 2021
Accepted:
September 15,
2021
Received in revised form:
July 29,
2021
Received:
June 5,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
