OUTCOMES OF FERTILITY-SPARING SURGERY IN WOMEN WITH EARLY- STAGE CERVICAL CANCER – CASE SERIES

Abstract

Background: Globally, cervical cancer is the fourth most common and fourth leading cause of death among malignancies in women. In young women with early-stage cervical cancer (FIGO IA1-IB1) and low risk who wish to preserve their reproductive options, there are alternative surgical methods. They allow with minimal risk to treat the disease with a good prospect of getting pregnant and carrying the pregnancy. These methods include conization, simple trachelectomy, and radical trachelectomy, which can be performed via vaginal access, abdominal access, or minimally invasive (laparoscopic or robotic surgery). This case series examines the outcomes of fertility-sparing surgery in women with early-stage cervical cancer, focusing on the unique application of robotic-assisted techniques and their impact on preserving reproductive potential. Material and methods: This study includes five women aged 33-44 with early-stage cervical cancer who underwent fertility-sparing surgeries from March 2022 to March 2024. Surgical methods included simple trachelectomy and robot- assisted trachelectomy with pelvic lymph node dissection, performed at Saint Marina University Hospital - Pleven. Results: Key outcomes measured were operative time, hospital stay, intraoperative and postoperative complications, and reproductive success. There are no intraoperative complications. One early postoperative complication was registered - uncomplicated lymphocele. The operative time for robot-assisted tachelectomies is 105 and 120 minutes, respectively and a hospital stay of 4 days. The simple trachelectomies show an operative time between 30 and 45 minutes and a hospital stay of 2 days. No abnormal blood loss was noted. Тwo pregnancies were reported among patients - one conceived naturally and one by ART. Follow-up periods ranged from 3 to 24 months, with no cancer recurrences reported. Conclusion: Fertility-sparing surgeries demonstrate promising oncological and reproductive outcomes in selected patients with early-stage cervical cancer. These findings support the potential for broader application in clinical practice, emphasizing the importance of specialized surgical expertise.