Fertility-Sparing Treatment of Early and Locally Advanced Cervical Cancer

With the advent of improved widespread screening for cervical cancer, the number of patients diagnosed with early stage disease, and with that, the proportion of those of child-bearing age who wish to preserve their fertility, is increasing. The prognosis of these patients is considerably more positive than patients with advanced disease, and fertility-sparing options should be carefully considered. In this chapter, we discuss the treatment approaches that could achieve such an outcome, including radical trachelectomy (RT), and compare RT with the effects of radical hysterectomy. We describe the criteria for patient selection to achieve the best oncological outcome and the importance of pre-operative assessment, such as imaging, to determine patient suitability for RT. The advantages and disadvantages of various surgical methods for RT are considered, including abdominal and vaginal approaches and laparoscopic and robotic techniques, as well as the impact of frozen section analysis, uterine artery preservation, and cervical cerclage on successful treatment. Complications associated with these approaches are also explored, including the risk of miscarriage in women who have undergone RT. The chapter concludes with an overview of the impact of RT on oncological and obstetric outcomes, including patient survival and successful full-term delivery following appropriate perinatal management.