Reducing radicality in fertility-sparing surgery is associated with improved in vitro fertilization outcome in early-stage cervical cancer: A national retrospective study

• Published in: Gynecologic oncology Vol. 186; pp. 35 - 41
• Main Authors: Vesztergom, Dóra, Téglás, Gyöngyvér, Bahrehmand, Kiarash, Török, Attila, Balla, Levente, Forgács, Vince, Konc, János, Tándor, Zoltán, Várnagy, Ákos, Boga, Péter, Zádori, János, Sipos, Miklós, Mánfai, Zoltán, Novák, Zoltán
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2024
• Subjects: Early-stage cervical cancer; Fertility preservation; Fertility-sparing surgery; IVF outcomes; Radical trachelectomy; Uterine artery preservation; Fertility preservation; Fertility-sparing surgery; Radical trachelectomy; IVF outcomes; Early-stage cervical cancer; Uterine artery preservation
• ISSN: 0090-8258; 1095-6859; 1095-6859
• DOI: 10.1016/j.ygyno.2024.03.024

Fertility-sparing surgery (FSS) aims to achieve oncological outcomes that are non-inferior to radical treatment while preserving fertility and optimizing reproductive results. This study assesses in vitro fertilization (IVF) outcomes in early-stage cervical cancer survivors following FSS, comparing radical and non-radical approaches. This retrospective analysis used data from Hungary's National Health Insurance Fund (2004–2022) on patients who underwent IVF treatment following FSS for early-stage cervical cancer at ten Hungarian fertility clinics. Patients were classified into radical and non-radical surgical groups, with the uterine arteries being spared in the non-radical procedures. RStudio (R software version: 4.2.2) was used for statistical analysis. Student's t-test was used to compare group means, and Fisher's exact test was applied to assess independence and distributions between categorical variables, and to estimate odds. The study analyzed data from 122 IVF treatment cycles involving 36 patients. The non-radical group had a significantly higher live birth rate (83%, 5/6 compared to the radical group (17%, 5/30). Additionally, the non-radical group had a significantly higher implantation rate and cumulative live birth rate per oocyte retrieval (37%, 7/19 and 55%, 6/11 respectively) compared to the radical group (8%, 12/148 and 6%, 5/80 respectively). This is the largest study to evaluate IVF outcomes in young cervical cancer survivors who have undergone FSS. The findings suggest that less radical procedures are associated with significantly better IVF outcomes. These results emphasize the importance of considering oncological safety and reproductive outcomes together when choosing FSS for early-stage cervical cancer patients. It also highlights the reproductive benefits of performing less radical surgery. •IVF outcomes were analyzed in cervical cancer survivors treated by fertility-sparing surgery.•Radical fertility sparing procedures were associated with lower cumulative live birth rates.•Reduced implantation rate may be the key factor explaining worse IVF outcome in patients with uterine artery ligation.•Decreased radicality and uterine artery sparing is advocated to optimize reproductive outcomes.