Fertility-sparing surgery for cervical cancer has same outcome as hysterectomy

Fertility-sparing surgery for cervical cancer, without hysterectomy, may have similar outcomes to more radical surgery in women with small tumours.

At present, women with stage I cervical cancers with tumours over two centimetres are advised to undergo standard surgery. This involves the removal of the womb, known as a hysterectomy. Women who undergo this procedure are therefore unable to carry a pregnancy. However, the effect on life expectancy of fertility-sparing surgery where the cervix and not the womb is removed, particularly in those with larger tumours, has not been clear. Researchers from the University of Texas MD Anderson Cancer Centre in Houston compared the life expectancy of women who had undergone different surgeries.

In the American Journal of Obstetrics and Gynaecology, they said: 'Although some guidelines consider patients with tumours over two centimetres to be ineligible for fertility-sparing surgery, we found no evidence that fertility-sparing surgery was associated with inferior life expectancy when compared with standard surgery at any tumour size up to four centimetres.'

The research team employed a retrospective analysis of the National Cancer Database. They filtered the data for women aged 45 or under who were diagnosed with stage I cervical cancer between 2006 and 2018, with tumours four centimetres or less in width.

The team included patients who had undergone either fertility-sparing surgery or standard surgery as their primary treatment, resulting in 897 in each group.

They found that the five-year survival rate was similar between the two groups across all tumour sizes. However, the data were more precise for smaller tumours because there were fewer patients with tumour sizes greater than two centimetres who had undergone fertility-sparing surgery.

This difference in precision is compatible with a 0.67-month difference in life expectancy for those with one-centimetre tumours, compared with a potential 3.79-month difference in those with four-centimetre tumours.

Both the US and European guidelines do not recommend the use of fertility-sparing surgery in patients with cervical tumours larger than two centimetres. However, the authors argue that 'a two-centimetre cut-off is arbitrary… The current guidelines rely on a limited number of studies, some of which excluded patients with tumours larger than two centimetres.'

Therefore, based on these data, the authors hope that: 'Fertility-sparing treatment may be an option for select patients with tumours up to four centimetres in size' – which would make these procedures available to more women each year.