After Radical Trachelectomy: Reproductive and Obstetrical Outcomes of Fertility-Sparing Surgery for Cervical Cancer

Abstract

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.

Keywords

cervical cancer - fertility-sparing surgery - pregnancy - obstetric - trachelectomy

Publikationsverlauf

Artikel online veröffentlicht:
17. April 2025

• References

• 1 Lynge E, Bennekou Schroll J, Andersen B. et al. Cervical cancer incidence in Denmark: disentangling determinants of time trend. Int J Cancer 2024; 155 (10) 1769-1779
• 2 Arbyn M, Weiderpass E, Bruni L. et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health 2020; 8 (02) e191-e203
• 3 Hughes T, Harper A, Gupta S. et al. The current and future global burden of cancer among adolescents and young adults: a population-based study. Lancet Oncol 2024; 25 (12) 1614-1624
• 4 Cibula D, Raspollini MR, Planchamp F. et al. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer - update 2023. Int J Gynecol Cancer 2023; 33 (05) 649-666
• 5 Batman SH, Schmeler KM. Fertility-sparing and less radical surgery for cervical cancer. Curr Oncol Rep 2022; 24 (11) 1541-1548
• 6 Dargent D, Martin X, Sacchetoni A, Mathevet P. Laparoscopic vaginal radical trachelectomy: a treatment to preserve the fertility of cervical carcinoma patients. Cancer 2000; 88 (08) 1877-1882
• 7 Han S, Na J, Li Y, Wang J. Surgical procedures and techniques in robot-assisted uterine artery-preserving radical trachelectomy. J Robot Surg 2024; 18 (01) 222
• 8 Hauerberg L, Høgdall C, Loft A. et al. Vaginal radical trachelectomy for early stage cervical cancer. results of the Danish National Single Center Strategy. Gynecol Oncol 2015; 138 (02) 304-310
• 9 Li X, Li J, Wu X. Incidence, risk factors and treatment of cervical stenosis after radical trachelectomy: a systematic review. Eur J Cancer 2015; 51 (13) 1751-1759
• 10 Ekdahl L, Paraghamian S, Eoh KJ. et al. Long term oncologic and reproductive outcomes after robot-assisted radical trachelectomy for early-stage cervical cancer. An international multicenter study. Gynecol Oncol 2022; 164 (03) 529-534
• 11 Frøding LP, Ottosen C, Mosgaard BJ, Jensen PT. Quality of life, urogynecological morbidity, and lymphedema after radical vaginal trachelectomy for early-stage cervical cancer. Int J Gynecol Cancer 2015; 25 (04) 699-706
• 12 Froeding LP, Ottosen C, Rung-Hansen H, Svane D, Mosgaard BJ, Jensen PT. Sexual functioning and vaginal changes after radical vaginal trachelectomy in early stage cervical cancer patients: a longitudinal study. J Sex Med 2014; 11 (02) 595-604
• 13 Nezhat C, Roman RA, Rambhatla A, Nezhat F. Reproductive and oncologic outcomes after fertility-sparing surgery for early stage cervical cancer: a systematic review. Fertil Steril 2020; 113 (04) 685-703
• 14 Li X, Xia L, Li J, Chen X, Ju X, Wu X. Reproductive and obstetric outcomes after abdominal radical trachelectomy (ART) for patients with early-stage cervical cancers in Fudan, China. Gynecol Oncol 2020; 157 (02) 418-422
• 15 Siegler K, Plaikner A, Hertel H. et al. Oncologic and fertility outcomes after simple trachelectomy in women with early cervical cancer. J Minim Invasive Gynecol 2024; 31 (02) 110-114
• 16 Fricová L, Kommoss S, Scambia G. et al. Reproductive outcomes after fertility-sparing surgery for cervical cancer - results of the multicenter FERTISS study. Gynecol Oncol 2024; 190: 179-185
• 17 Kohler C, Plaikner A, Siegler K. et al. Radical vaginal trachelectomy: long-term oncologic and fertility outcomes in patients with early cervical cancer. Int J Gynecol Cancer 2024; 34 (06) 799-805
• 18 Zhang Q, Li W, Kanis MJ. et al. Oncologic and obstetrical outcomes with fertility-sparing treatment of cervical cancer: a systematic review and meta-analysis. Oncotarget 2017; 8 (28) 46580-46592
• 19 Bentivegna E, Maulard A, Pautier P, Chargari C, Gouy S, Morice P. Fertility results and pregnancy outcomes after conservative treatment of cervical cancer: a systematic review of the literature. Fertil Steril 2016; 106 (05) 1195-1211.e5
• 20 Taliento C, Scutiero G, Battello G. et al. Reproductive, obstetrical and oncological outcomes of fertility-sparing treatment for cervical cancer according to the FIGO 2018 staging system: A systematic review. Eur J Surg Oncol 2025; 51 (01) 109359
• 21 Vesztergom D, Téglás G, Bahrehmand K. et al. Reducing radicality in fertility-sparing surgery is associated with improved in vitro fertilization outcome in early-stage cervical cancer: a national retrospective study. Gynecol Oncol 2024; 186: 35-41
• 22 Nøhr B, Tabor A, Frederiksen K, Kjaer SK. Loop electrosurgical excision of the cervix and the subsequent risk of preterm delivery. Acta Obstet Gynecol Scand 2007; 86 (05) 596-603
• 23 Kasuga Y, Ikenoue S, Tanaka M, Ochiai D. Management of pregnancy after radical trachelectomy. Gynecol Oncol 2021; 162 (01) 220-225
• 24 Schmeler KM, Pareja R, Lopez Blanco A. et al. ConCerv: a prospective trial of conservative surgery for low-risk early-stage cervical cancer. Int J Gynecol Cancer 2021; 31 (10) 1317-1325
• 25 Plante M, Kwon JS, Ferguson S. et al; CX.5 SHAPE Investigators, CX.5 SHAPE Investigators. Simple versus radical hysterectomy in women with low-risk cervical cancer. N Engl J Med 2024; 390 (09) 819-829