104 Conservative surgery in fertility sparing management of early stage cervical cancers – a review of oncologic and reproductive outcomes at a tertiary centre in Australia

Introduction Less radical, fertility-preserving surgery in early stage cervical cancer has been an area of interest. We review the oncologic and reproductive outcomes of cases treated with cone biopsy or simple vaginal trachelectomy (SVT) with pelvic lymph node assessment at a tertiary institution in Australia. Methods Patients diagnosed with stage IA1 with lymphovascular invasion (LVSI), IA2 and IB1 cervical cancer, who underwent conservative fertility-sparing surgery of cone biopsy or SVT with either sentinel lymph node biopsy (SLNB) or pelvic lymphadenectomy (PLND), from 2002 to 2018 were included. Data was reviewed retrospectively. Results 28 patients were included; 14 underwent cone biopsy and 14 underwent SVT. All cases underwent nodal assessment by SLN (n=10, 35.7%) or PLND (n=18, 64.3%). Median age was 31.5. 82.1%(23/28) were nulliparous. By the FIGO 2009 staging criteria, stage was IA1, IA2 and IB1 in 2(7.1%), 4(14.3%) and 22(78.6%) cases, respectively. Reclassifying by the FIGO 2018 staging criteria, stage distribution of cases was 12(42.9%), 7(25.0%), 7(25.0%) and 2(7.1%) for IA1, IA2, IB1 and IB2, respectively. 11 had adenocarcinoma, 10 had squamous cell carcinoma, 7 were of other histologic subtypes. 6(21.4%) had positive LVSI. 3(10.7%) were found to have nodal metastasis on histology. 4(14.3%) patients underwent adjuvant chemoradiation. Median follow-up duration was 66.5 months. Disease recurred in 1(3.6%) patient. 5-year disease-free survival was 96.4%. Of the 21 patients who were eligible and attempted to conceive post-treatment, there were 21 pregnancies and 10 livebirths. Conclusion Conservative surgery of cone biopsy or SVT with nodal assessment is a valid fertility-preserving treatment option in carefully selected cases.