Excisional cone as fertility-sparing treatment in early-stage cervical cancer

Objective To describe a case series of early-stage cervical cancer patients treated with excisional cone instead of radical trachelectomy as fertility-sparing surgery. Design Prospective study. Setting University hospital. Patient(s) Early-stage cervical cancer (International Federation of Gynecology and Obstetrics stage IA2–IB1), age ≤45 years, tumor ≤20 mm. Intervention(s) Cold-knife conization and laparoscopic pelvic lymphadenectomy. Main Outcome Measure(s) Recurrence and pregnancy rate. Result(s) There were 17 patients: 4 (23.5%) IA2, 13 (76.5%) IB1; 12 (70.5%) squamous cell carcinoma, 4 (23.5%) adenocarcinoma, and 1 (6%) glassy cell tumor. Four cases (23.5%) involved lymphovascular space invasion. The median number of lymph nodes removed was 18 (range 13–51). None of the patients received neoadjuvant chemotherapy, and two patients (12%) received three courses of adjuvant chemotherapy. No recurrences were observed after a median follow-up of 16 months (range 8–101 months). Two of five patients (40%) attempting to conceive had a spontaneous pregnancy and delivery. Conclusion(s) In selected and informed patients, conization and laparoscopic pelvic lymphadenectomy seems to be feasible as a fertility-sparing surgical approach.