Trachelectomy Research Articles

To present reproductive and oncological outcomes of radical trachelectomy (RT) in patients with cervical adenocarcinomas (AC). This retrospective study included 51 patients with cervical AC who underwent RT at Peking Union Medical Hospital from January 1, 2005 to June 1, 2023. Five patients (9.8%) experienced cervical stenosis following RT, which likely occurred in cases of abdominal RT (50%) and virginal prophylactic cerclage (33.33%) and those without copper T intrauterine devices during RT (20%). In total, 30 patients (58.82%) attempted to conceive, and 11 (36.67%) succeeded. Five patients (45.45%) achieved pregnancy with fertility assistance. The mean surgery-pregnancy interval was 27 months (range, 17-118). Two preterm and two full-term births were achieved. With a median follow-up of 50 months (range, 7-238), seven patients (13.73%) experienced recurrence and three (5.88%) died. Six of seven patients relapsed beyond the residual cervix. The cancer recurrence rate (CRR) was 5.88% for patients with pre-cervical conization and 17.65% for those with biopsy (p = 0.250); 11.63% had human papillomavirus-associated (HPVA) disease and 25% had non-HPVA (NHPVA)(p = 0.313). The cancer death rate (CDR) was 4.65% with HPVA and 12.50% with NHPVA (p = 0.386); 13.63% had the endogenous type and 0 had the exogenous type (p = 0.04). Chemotherapy in patients with risk factors resulted in better CRR and CDR than in those without (5.88% vs. 17.65%, 0% vs. 8.82%). The cumulative 5-year recurrence-free survival (RFS) and overall survival rates were 82.03% and 94.39%, respectively. RT in patients with AC led to an acceptable pregnancy rate but a higher CRR and lower 5-year RFS. Careful patient selection for RT, combined with adjuvant chemotherapy when indicated, is crucial to optimize the balance between reproductive and oncological outcomes in AC.

Fertility-sparing treatments (FSTs) have gained importance for young female cancer patients, especially those with early-stage cervical, ovarian, and endometrial cancers. However, concerns about the long-term safety of these procedures, particularly in more advanced cancers, persist. A literature review was conducted using databases such as PubMed, Scopus, and Web of Science. The search terms included “fertility preservation” and “gynaecological cancer”. Articles published between 2014 and 2024 were considered, with 39 articles cited in the paper. The inclusion criteria were female patients undergoing FST. Studies were excluded if prior treatments impacted fertility or if oncological outcomes were inadequately reported. Radical trachelectomy, laparoscopic fertility-sparing surgeries, and cryopreservation techniques, such as ovarian tissue vitrification and oocyte cryopreservation, offer viable options for preserving fertility in early-stage gynecological cancer patients. Radical trachelectomy and cryopreservation showed positive reproductive outcomes, with pregnancy rates of 30–50% in early-stage cases. GnRH analogs during chemotherapy also demonstrated benefits in maintaining fertility. Despite these advances, recurrence in more advanced stages (FIGO IA2 and beyond) remains a concern. Minimally invasive surgeries like robotic-assisted procedures demonstrated comparable fertility outcomes to traditional methods but with fewer complications. FST is a promising option for women with early-stage cancer, offering favorable reproductive and survival outcomes. However, further research is needed to confirm long-term oncological safety in advanced stages. Multidisciplinary approaches and individualized treatment planning are essential for optimizing outcomes.

Evaluation of toxicity after radical hysterectomy or trachelectomy and postoperative pelvic intensity-modulated radiation therapy with concurrent chemotherapy for cervical cancer

Cervical cancer is a major health issue worldwide, with approximately 660,000 new cases a year, particularly in women of reproductive age (47.4 ± 12.8 years at diagnosis). Current advances in screening and immunization have shifted cervical cancer diagnoses to earlier stages; as a result, fertility preservation is an essential component of building a treatment plan. Objectives: This systematic review aims to synthesize the existing techniques for fertility preservation with a focus on early-stage cervical cancer (cancer stage IA1-IB1). We will describe the different surgical and medical approaches for the treatment of cervical cancer, followed by an analysis of their oncologic safety and the associated reproductive risks and outcomes. Methods: A descriptive synthesis of the strategies for surgical management, including conization, radical trachelectomy, neoadjuvant chemotherapy (NACT), and radiotherapy, was completed. Fertility and successful pregnancy rely on patient selection, prognostic variables, and obstetric outcomes. The use of transposition of the ovaries and cryopreservation in the context of gonadotoxic treatment plans also requires investigation. Results: For patients meeting conservative eligibility criteria, conservative surgery for tumors up to 2 cm has been considered a safe oncological management strategy, although evidence remains limited. Pregnancy rate after conization ranged from 36 to 55% and 10 to 38% after radical trachelectomy. Ovarian function can be successfully preserved in >60% of laparoscopic transposition cases but resulted in a less than 15% chance of natural conception; the need for assistive reproductive techniques was often required. Conclusions: Fertility-preserving management of cervical cancer is safe and feasible in carefully selected patients, with oncologic outcomes comparable to more radical management. Continued innovation and randomized control trials in treatment paths and oncologic and fertility outcomes will benefit the field.

BackgroundGiven the excellent prognosis of early-stage cervical cancer, fertility-sparing surgery has grown as a priority, significant alternative for radical hysterectomy in women being of reproductive age. We aimed to investigate the outcomes and subsequent pregnancies of early-stage cervical cancer patients who received radical trachelectomy. Moreover, there is a scarcity of literature directly comparing the impact of whether performing cervical cerclage concurrently with radical trachelectomy on patients’ reproductive outcomes.MethodsWomen with IA1-IB2 cervical cancer who underwent fertility-sparing surgery at the Obstetrics and Gynecology Hospital of Fudan University were reviewed from January 2014 to May 2024.Radical trachelectomy in 70 women was performed by surgical team from the gynecologic oncologic center. Clinical characteristics, intraoperative, pathological results, oncologic, fertility and follow-up data of these patients were recorded and retrospectively analyzed. This study compared surgical and perinatal outcomes between patients who underwent cervical cerclage during radical trachelectomy (n=49) and those who did not receive the procedure simultaneously (n=21).ResultsA total of 70 women (mean age: 31years) underwent radical trachelectomy (RT) of whom 68.6% were nulliparous. The FIGO stage distribution was IA1 (n=6), stage IA2 (n=7), stage IB1 (n=49), and stage IB2 (n=8). The operative duration was significantly longer in the cerclage group than in the control group (285.4±63.9 min vs 204.8±61.9 min; p < 0.001, 95% CI 47.51-113.48) with greater intraoperative blood loss (201.0 mL vs 170.1 mL, p=0.187, 95% CI -15.10-75.72). Overall, 36 women (51.4%) were seeking parenthood, and 26 succeeded (72.2%). There were 20 live births (76.9%), 12 women delivered in term (46.2%), 7 infants were born between 32 and 36+6 weeks, 1 between 28 and 31+6 weeks, all live birth. The mean neonatal birth weight was slightly lower in the cerclage group than in the control group (2625 g vs 2828.6 g; p=0.265, 95% CI -575.17 to 168.03). At the end of the follow-up period (median 68.7 months, range 34–153 months), one individual is currently 27+3 weeks pregnant, three patient had recurrence, and all women are alive and 20 children born to fertility-sparing surgery patients exhibited normal development.ConclusionRadical trachelectomy provides excellent oncologic results with an outstanding fertility rate and obstetric outcome for patients with early cervical cancer. RT combined with intrauterine-cervical stent is a safe and effective fertility-sparing surgery but cervical cerclage is not recommended.

The Silva pattern-based classification and oncological outcomes in women undergoing fertility-sparing surgery for early-stage cervical cancer.

Background/Objectives: Obstetrical monitoring following radical trachelectomy (RT) for cervical cancer is marked by the lack of a standardized protocol, which may lead to delays in the intervention for cervical shortening. In light of the typical cervical remodeling process that occurs at the onset of labor, we hypothesized that the onset of premature cervical shortening in patients who have undergone radiotherapy commences at the internal ostium. Methods: We introduced the concepts of internal distance (distance between internal cervical ostium and cerclage thread) and the latent shortening of internal distance, which is characterized as a painless reduction in the internal distance, serving as an early marker of preterm contractions, thus enabling timely tocolytic intervention. Results: Three patients spontaneously conceived after RT. They were obstetrically followed-up after RT, using a combined approach of transvaginal ultrasound cervical markers and cardiotocography. Active tocolysis was used if internal distance shortening was observed. All patients delivered term healthy babies. Conclusions: The consistent ultrasound evaluation of both internal and external distances permits the proactive diagnosis of premature contractions and enables swift therapeutic measures.

Robotic radical trachelectomy in early stage cervical cancer

Introduction: Conization is a standard fertility-preserving treatment for stage IA1 cervical cancer; however, its role in stage IA2 disease remains controversial due to limited supporting evidence. This study aimed to evaluate the feasibility of conization with or without sentinel lymph node (SLN) biopsy as a fertility-sparing strategy in patients with stage IA2 cervical cancer.Methods: We retrospectively analyzed 20 patients diagnosed with stage IA2 cervical cancer based on conization pathology who subsequently underwent modified radical or radical hysterectomy or trachelectomy with SLN biopsy at Kagoshima University Hospital between March 2014 and December 2023. SLN mapping was performed using a hybrid technique combining technetium-99m and indocyanine green. Residual tumor presence in hysterectomy specimens and associated clinicopathologic factors were evaluated.Results: The median age was 45 years. Histologic subtypes included squamous cell carcinoma (75%) and adenocarcinoma (25%). SLN mapping was successfully performed bilaterally in all patients (100%), with no SLN metastases detected. Residual tumor was identified in eight patients (40%). Positive endocervical curettage (ECC) was significantly associated with residual tumor (OR = 3.38, 95% CI: 1.31-8.76, p = 0.035). Notably, no residual tumor was observed in patients with both negative ECC and negative endocervical margins. Among the five patients who underwent trachelectomy, all preserved their fertility potential during the follow-up period, and no recurrences were observed during a median follow-up of 45 months.Conclusion: In patients with stage IA2 cervical cancer, positive ECC and adenocarcinoma histology were significantly associated with residual tumor in the final hysterectomy specimen. Importantly, no residual tumor was observed in patients with both negative ECC and negative endocervical margin, particularly among those with squamous cell carcinoma. These findings suggest that for highly selected patients, especially those with squamous histology, conization ± SLN biopsy may represent a safe and less invasive fertility-preserving alternative to trachelectomy. Further prospective studies are needed to confirm oncologic safety and define appropriate selection criteria, particularly for cases of adenocarcinoma.

Oncologic and Fertility Outcomes Following Radical Trachelectomy in Early-stage Cervical Cancer: Insights from a Single-institution in Malaysia

Objective: This review re-evaluates fertility-sparing surgery (FSS) in cervical cancer, synthesizing advancements in surgical precision, evolving indications, and sociodemographic factors influencing care access. It emphasizes the importance of multidisciplinary collaboration and equitable access to optimize both reproductive and survival outcomes for young patients. Mechanism: A systematic search was performed across PubMed, Embase, and Web of Science for studies published in the past ten years, using key terms related to cervical cancer, FSS, oncologic and obstetric outcomes, and social determinants of health. Due to heterogeneity in study designs and outcome reporting, a narrative synthesis was conducted to analyze trends in surgical techniques, oncologic safety, obstetric outcomes, and sociodemographic disparities. Findings in Brief: FSS encompasses procedures such as conization, radical trachelectomy (vaginal, abdominal, or minimally invasive), and neoadjuvant chemotherapy (NACT)- facilitated surgery, tailored to the tumor stage, size, and histology. Sentinel lymph node (SLN) mapping minimizes invasiveness during staging, while ovarian transposition (OT) preserves endocrine and reproductive function during pelvic radiotherapy. Multidisciplinary teams (MDTs) consider tumor biology, nodal status, and patient preferences to guide treatment decisions. Conclusions: FSS offers cervical cancer patients with oncologic safety and fertility preservation, but its success relies on a multidisciplinary approach. Factors like surgical expertise, patient characteristics, and social determinants-like insurance coverage and access to care-significantly influence outcomes. Future research should prioritize improving multidisciplinary care and addressing disparities to enhance fertility preservation for all patients.

Clear cell adenocarcinoma of the uterine cervix (CCAC) or vagina (CCAV) is rare and usually presents in postmenopausal women. Paediatric cases are rare, and have historically been associated with intrauterine exposure to diethylstilbestrol (DES). We aimed to summarise outcomes of CCAC and CCAV in children with no history of DES exposure. Systematic review of the Pubmed/Medline/Ovid databases from inception to 2024 according to PRISMA guidelines. The initial search identified 127 articles, and 29 articles were included in the final analysis. Forty-three cases of paediatric CCAC and CCAV were described. Median age at presentation was 10years [interquartile range (IQR): 8-14years]. Most patients presented with stage I tumours and symptoms of prolonged vaginal bleeding. Staging assessment included CT or MRI abdomen/pelvis and vaginoscopy with biopsy in most cases. Treatments consisted of variable combinations of chemotherapy, radiotherapy (external beam or brachytherapy) and surgery. Surgical procedures included localised resection only, radical trachelectomy or radical hysterectomy with pelvic lymph node clearance. Follow-up information was available for 88% patients and was overall very heterogeneous. Median duration of follow-up was 24months [IQR: 14-82.5]. There were seven reported deaths, and two additional patients experienced recurrence during follow-up. This is the first systematic review on the management and outcomes of children with CCAC and CCAV. The cases identified were few and heterogeneous, with limited information on longer term outcomes. Current evidence does not allow for the generation of paediatric-specific treatment guidelines. A cautious approach to the management of this rare and aggressive disease is essential, carefully balancing the desire of fertility preservation with the need for cure from disease.

Введение. Среди злокачественных новообразований органов женской репродуктивной системы рак шейки матки занимает лидирующие позиции по показателям как заболеваемости, так и смертности. Традиционное хирургическое лечение ранних стадий рака шейки матки приводит к удовлетворительным онкологическим результатам, однако необратимо снижает фертильность данной категории больных. В последние годы в клинической онкогинекологической практике активно внедряется способ органосохраняющего лечения в объеме радикальной трахелэктомии для лечения пациенток с инвазивным раком шейки матки. Цель. Оценка репродуктивных и онкологических результатов у пациенток с инвазивным раком шейки матки, получивших органосохраняющее хирургическое лечение в объеме радикальной трахелэктомии с укреплением маточно-влагалищного анастомоза имплантом с памятью формы из никелида титана. Материалы и методы. За период 2010−2024 гг. на базе НИИ онкологии Томского НИМЦ РАН и института онкологии и нейрохирургии НМИЦ им. Е.Н. Мешалкина были пролечены в объеме радикальной трахелэктомии с укреплением маточно-влагалищного анастомоза имплантом с памятью формы из никелида титана 168 пациенток с впервые выявленным диагнозом инвазивный рак шейки матки. Произведена оценка онкологических и репродуктивных результатов. Результаты. Из общего числа больных всего зарегистрировано 39 беременностей. В настоящее время родились 28 здоровых детей. Две пациентки стали матерями дважды, одна женщина родила двойню. Медиана наблюдения за данной категорией больных составляет 89 ± 9,6 мес. У восьми женщин зарегистрированы рецидивы в различные сроки наблюдения с локализацией преимущественно в области анастомоза и подвздошных сосудов. Анализ менструальной функции показал, что продолжительность менструального цикла после хирургического лечения в объеме радикальной трахелэктомии составила 29 ± 4,7 дней и достоверно не отличалась от показателей перед операцией. Продолжительность менструаций также достоверно не отличалась до и после хирургического лечения. Выводы. Совершенствование способа хирургического органосохраняющего лечения в объеме радикальной трахелэктомии с использованием технологий, разработанных в НИИ онкологии Томского НИМЦ, способствует улучшению репродуктивных результатов без ущерба для онкологической эффективности.

BackgroundPreterm birth is the most important cause of neonatal morbidity and mortality. Clinical guidelines recommend assessment of risk of preterm birth and implementation of interventions to reduce preterm birth risk through dedicated preterm birth clinics. We hypothesized that a two-tier preterm birth clinic pathway can safely manage women at the highest risk of preterm birth while reducing intervention for women at moderate risk of preterm birth. We aimed to test this hypothesis by evaluating risk factors, management, and outcomes of women attending a two-tier preterm birth prevention service.MethodsWe conducted a retrospective cohort study of women who gave birth between January and June 2021 at a tertiary hospital in Oxford, UK. We included two cohorts: women attending a Cervical Screening Clinic and women attending a Preterm Birth Clinic, and we also reviewed all cases of births before 34 weeks over that time period. At the initial midwife appointment at 8–10 weeks’ gestation, risk factors for preterm birth were assessed. Pregnant women with moderate risk factors (previous preterm birth at 32+ 0 − 33+ 6 weeks, previous preterm prelabour rupture of membranes (PPROM) at 32+ 0 − 33+ 6 weeks, previous LLETZ / cone biopsy, known abnormal uterus, previous caesarean section at 10 cm dilatation, and multiple pregnancy) were referred to the Cervical Screening Clinic for a cervical length scan by a sonographer. Pregnant women with major risk factors (previous preterm birth at 16+ 0 − 31+ 6 weeks, previous PPROM at less than 32+ 0 weeks, radical trachelectomy, previous cervical cerclage) as well as those with a cervix < 25 mm at any scan were referred to the Preterm Birth Clinic for a cervical length scan and counselling by a specialist obstetrician. Detailed information on risk factors, management, and perinatal outcomes were collected from case notes and analysed.Results189 women attended the Cervical Screening Clinic: 79.1% had a moderate risk factor for preterm birth, 100% had a cervical length scan, 7% had a short cervix and 4.2% received an intervention. All 196 infants were live born, with overall preterm birth rates of 14.8% at < 37 weeks, 3.1% at < 32 weeks, and 0% at < 28 weeks. The spontaneous live preterm birth rates were 9.7% at < 37 weeks, 2.6% at < 32 weeks and 0% at < 28 weeks. 79 women attended the Preterm Birth Clinic: 87.3% had a major risk factor for preterm birth, 100% had ≥ 1 cervical length scan, 41.3% had a short cervix, 78.1% received vaginal progesterone, and 39% had a cervical cerclage. Overall preterm birth rates were 33.8% at < 37 weeks, 10.3% at < 32 weeks and 4.4% at < 28 weeks. Spontaneous live preterm birth rates were 22.1% at < 37 weeks, 7.4% at < 32 weeks, and 2.9% at < 28 weeks. 115 women gave birth to 130 babies before 34 weeks: 80% had no major risk factor for preterm birth, 29% had a cervical length scan and less than 15% had an intervention. Over 90% had a live birth, but the neonatal death rate was high (8.5%).ConclusionWomen with moderate risk factors for preterm birth seen in the Cervical Screening Clinic had low rates of intervention and good perinatal outcomes. Most women with major risk factors were appropriately referred and managed by the Preterm Birth Clinic. This two-tier preterm birth prevention service therefore appears safe and effective.

AimClear cell carcinoma of the uterine cervix (CCCUC) is a rare disease, accounting for 4% to 9% of cervical adenocarcinomas. Because it is so rare, its pathogenesis is largely unknown, and the standard treatment is unclear due to a lack of prospective studies. Our aim is to investigate the clinical features, treatment, and prognosis of CCCUC.MethodsWe retrospectively evaluated the clinical characteristics, treatment choices, and outcomes of 12 patients with CCCUC treated at our institution between January 2009 and July 2024.ResultsThe median patient age was 62.5 years (range, 14–90 years). The most common stage was IB (IA, n = 3; IB, n = 4; IIB, n = 1; IIIC, n = 2; IVB, n = 2). Ten patients underwent surgery as initial treatment: 6 underwent radical hysterectomy plus pelvic lymphadenectomy (PLD) or sentinel lymph node biopsy (SLNB), with or without para‐aortic lymphadenectomy (PALD); 3 underwent modified radical hysterectomy plus PLD with or without PALD; and 1 underwent radical trachelectomy with SLNB as fertility‐preserving surgery. All patients underwent bilateral salpingo‐oophorectomy except for the patient who opted for radical trachelectomy. Five patients received adjuvant treatment: 3 received platinum‐based systemic chemotherapy (2 of whom had combination therapy with bevacizumab), and 2 received concurrent chemoradiotherapy. The median follow‐up was 43.5 months (range, 1–123 months). The 5‐year progression‐free survival rate was 64.5%.ConclusionSystemic platinum‐based chemotherapy with bevacizumab may be more effective than concurrent chemoradiotherapy as adjuvant therapy for CCCUC.

ObjectiveThe importance of minimally invasive fertility-sparing surgery for cervical cancer is gaining increasing interest, both to achieve a cure and for future fertility. Procedures for robotic radical trachelectomy involving uterine reconstruction are not fully established.MethodsThis study prospectively verified the feasibility and safety of robotic radical trachelectomy between February 2018 and May 2022. The criteria were almost identical to those for our standard abdominal radical trachelectomy. Larger tumors (> 2 cm in diameter) were acceptable for surgery, provided a secure ≥ 1 cm cancer-free space was identified between the tumor and internal os.ResultsEight patients (median age, 32 y) were registered; the median body mass index was 21.8, and the median tumor size was 11.5 mm (range 0–30 mm). Robotic radical trachelectomy could be achieved in all patients with hybrid sentinel lymph node navigation surgery, confirming the precise cervical amputation line with a newer small knob ultrasonography probe, adequate cervical cerclage with non-absorbable monofilament stitches, and avoiding looseness between vaginal–uterine anastomosis with uninterrupted barbed U-shaped sutures. None of the cases were converted to laparotomy or radical hysterectomy, and there were no major complications. The median follow-up period was 49.5 mo (range 21–58 mo) and no patient had disease recurrence.ConclusionRobotic radical trachelectomy is safe and feasible using newer technologies without reducing radicality; it is also less invasive. Procedures are consistently reproducible and have the potential to be generalized to minimally invasive approaches.

Radical trachelectomy has become an accepted fertility-sparing treatment for patients with early-stage cervical cancer. Despite its oncological safety, radical trachelectomy is associated with persistent sexual dysfunction and voiding issues, complicating long-term quality of life. Fertility outcomes demonstrate overall pregnancy rates ranging from 25.7-73%, with less radical procedures such as conization and simple trachelectomy reporting higher pregnancy rates compared with radical trachelectomy. Assisted reproductive treatments might be necessary due to complications such as cervical stenosis. During pregnancy, there is an elevated risk of miscarriage, preterm delivery, and premature rupture of membranes due to cervical shortening. However, less radical fertility-sparing procedures such as conization and simple trachelectomy demonstrate lower preterm delivery rates. Prophylactic cerclage, as well as close monitoring of cervical length during pregnancy, is essential, and cesarean section remains the recommended method of delivery. Recent studies suggest that less radical fertility-sparing procedures may provide comparable oncological safety while reducing complications, highlighting the need to reevaluate surgical approaches. This review provides an overview of reproductive and obstetrical outcomes in patients after treatment for early-stage cervical cancer with trachelectomy. This review additionally emphasizes the need for further research to refine fertility-sparing strategies.

Cervical cancer is a prevalent malignancy among women of reproductive age. For early-stage cervical cancer, nerve-sparing radical trachelectomy offers a fertility-preserving treatment option. This procedure aims to remove the cancerous tissue while preserving pelvic nerves necessary for uterine function, thereby maintaining fertility while achieving favorable oncologic outcomes. This study evaluated the obstetric and oncologic outcomes of nerve-sparing radical trachelectomy in patients with early-stage cervical cancer. Retrospective reviews were performed on eight patients who underwent nerve-sparing radical trachelectomy for stage IA2-IB1 cervical cancer, classified according to the International Federation of Gynecology and Obstetrics (FIGO). Six patients underwent nerve-sparing radical trachelectomy while preserving the uterine branches of the pelvic nerves, while two patients underwent conventional nerve-sparing radical trachelectomy. Two patients underwent abdominal surgery, and six patients underwent laparoscopic surgeries. The clinical stages included three patients with stage IA2 and five patients with stage IB1. The median follow-up period was 78 months (range, 15-114 months). In this study, 37.5% of the patients attempted conception. The pregnancy rate was 66.7%, with deliveries occurring at full term as well as at 34 gestational weeks. Cine magnetic resonance imaging revealed physiological endometrial movements in patients who underwent surgery. No patient developed recurrence, and none of the patients died. Early-stage cervical cancer patients may be safe candidates for nerve-sparing radical laparoscopic trachelectomy with preservation of the uterine branches of the pelvic nerves. Maintaining the uterine branches of the pelvic nerves may be crucial for strengthening uterine immunity and maintaining uterine peristalsis, which may contribute to improved pregnancy outcomes.

Background/Objectives: Fertility-sparing surgery (FSS) is a standard practice for managing early stage cervical cancer, yet significant variation exists in clinical approaches worldwide. Our objective was to ascertain current practices and preferences for cerclage use among expert centers globally regarding FSS in patients with early stage cervical cancer. Methods: We conducted a cross-sectional survey from May to July 2023 involving expert centers identified through their scientific contributions and participation in international workgroups and conferences.. The survey, comprising 27 questions, evaluated existing practices in FSS. Results: Out of the centers surveyed, 21 (36.2%) gynecologic oncologists responded. For tumors <2 cm, 86% of centers preferred radical trachelectomy, primarily via the vaginal approach, while 13.6% favored a simple trachelectomy. Three experts preferred simple trachelectomy (13.6%). For tumors >2 cm, 47.6% utilized neoadjuvant chemotherapy before trachelectomy. Others did not offer FSS or performed an abdominal radical trachelectomy. Over time, there has been a shift towards less radical surgeries for tumors <2 cm and increased use of neoadjuvant chemotherapy for larger tumors. Some abandoned the minimally invasive surgical approach. Nearly all experts (90.5%) placed a cerclage immediately following trachelectomy. Conclusions: The majority of experts opt for radical trachelectomy in early stage cervical cancer, with immediate cerclage placement being a common practice. However, considerable international variations highlight the urgent need for standardized guidelines and further research to optimize treatment strategies, balancing oncological safety with fertility outcomes.

Oncological outcomes after vaginal and robotic-assisted radical trachelectomy in patients with cervical cancer - A single-center prospective cohort study.