title: Fertility-sparing surgery in early-stage cervical cancer patients: oncologic and reproductive outcomes.
abstract: OBJECTIVE
  The aim of this study was to evaluate the safety, feasibility, and effectiveness of conservative management of early-stage cervical cancer (eCC) in young women willing to preserve their childbearing potential.
  
  
  METHODS
  Data of 22 consecutive young women (aged <40 years) undergoing conservative management of eCC were prospectively collected. Conservative management consists of cervical conization plus laparoscopic pelvic lymphadenectomy.
  
  
  RESULTS
  Median age was 32.5 years (range, 27-40 years). Twenty-one women (95%) were nulliparous. Histology included adenocarcinoma, squamous cell carcinoma, and adenosquamous carcinoma in 11 (50%), 10 (45%), and 1 (5%) patients, respectively. Six (27%) and 16 patients (73%) were affected by stage IA2 and IB1, respectively. The mean number of pelvic lymph node removed was 26 (SD, 8.6). After primary treatment, 3 patients required radical surgery due to the presence of metastatic nodes detected at the time of diagnostic lymphadenectomy. In addition, 1 patient (5%), after the successful execution of conservative treatment, asked for hysterectomy. After a mean follow-up of 48.8 (SD, 32.8) months, no recurrence was diagnosed among patients undergoing ultraconservative treatment, whereas 2 out of 3 patients with positive pelvic nodes who had radical hysterectomy developed recurrent disease. Considering the whole cohort, 5-year disease-free and overall survival rates were 85.9% and 93.7%, respectively. Looking at reproductive outcomes, 15 of 18 patients (4 patients had hysterectomy) attempted to conceive, and 8 (53%) women had spontaneous pregnancies
  
  
  CONCLUSIONS
  Conservative management for eCC seems to be associated with long-term oncologic effectiveness, preserving reproductive function. Further large prospective studies are warranted to improve patients' care.
authors: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors: Antonino
authors: A
authors: Ditto
authors: Fabio
authors: F
authors: Martinelli
authors: Giorgio
authors: G
authors: Bogani
authors: Margherita
authors: M
authors: Fischetti
authors: Violante
authors: V
authors: Di Donato
authors: Domenica
authors: D
authors: Lorusso
authors: Francesco
authors: F
authors: Raspagliesi
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000328:Adult; D018196:Carcinoma, Adenosquamous / Q000556:secondary / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000601:surgery*; D019092:Conization; D018572:Disease-Free Survival; D005260:Female; D059247:Fertility Preservation; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D059351:Organ Sparing Treatments; D010388:Pelvis; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*