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Fertility-sparing surgery for cervical cancer

Marie Plante, MD
Section Editors
Barbara Goff, MD
Vincenzo Berghella, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Discussion of fertility issues is an important part of pretreatment counseling for reproductive-age cancer patients [1]. Most young cancer survivors desire to eventually become parents; thus, the psychosocial impact of cancer-related infertility is significant, with a high proportion of these patients experiencing feelings of depression, grief, stress, and sexual dysfunction [2,3].

Concerns about fertility preservation are particularly common among women with gynecologic malignancies. Cervical cancer, in particular, is likely to impact young women; 46 percent of cases of cervical cancer are diagnosed in women <45 years old [4]. These young women may be candidates for fertility preservation options, such as radical trachelectomy, since most of their cancers are diagnosed at an early stage (table 1) when survival is over 90 percent [5]. Observational studies published in the past decade have reported good oncologic and obstetric outcomes after this procedure.

Fertility-sparing surgery for cervical cancer will be discussed here. Additional issues related to fertility and cancer are discussed separately. (See "Fertility preservation in patients undergoing gonadotoxic treatment or gonadal resection" and "Ovarian failure due to anticancer drugs and radiation" and "Overview of infertility and pregnancy outcome in cancer survivors".)


Radical hysterectomy is the standard surgical treatment for women with cervical cancer. In general, women with stage IA1 (table 1) disease may be treated with conization (or extrafascial hysterectomy). However, some other women are candidates for fertility-sparing surgery. These include women of reproductive age with early-stage disease (stage IA2 or IB1) who have no features of disease that are high risk for recurrence (ie, lesion size >2 cm, lymph node metastases). Lymphovascular space invasion (LVSI) within the tumor is a risk factor for lymph node recurrence, but as a sole finding, it is not a contraindication for fertility-sparing surgery. Options for fertility-preserving surgery include conization and radical trachelectomy (removal of the cervix and surrounding tissues with conservation of the uterus).


Conization — Women with stage IA1 disease (table 1) without lymphovascular space invasion (LVSI) are candidates for treatment with cervical cold knife conization alone [6]. A United States study of data from a national cancer database study (n = 1409) of women age ≤40 years with stage IA1 cervical cancer found no significant difference in five-year survival between those who underwent conization versus hysterectomy (98 versus 99 percent); data regarding LVSI were not available [7]. (See "Management of early-stage cervical cancer", section on 'Surgical treatment'.)

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Literature review current through: Nov 2017. | This topic last updated: Apr 20, 2016.
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  1. Loren AW, Mangu PB, Beck LN, et al. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2013; 31:2500.
  2. Carter J, Rowland K, Chi D, et al. Gynecologic cancer treatment and the impact of cancer-related infertility. Gynecol Oncol 2005; 97:90.
  3. Corney RH, Crowther ME, Everett H, et al. Psychosexual dysfunction in women with gynaecological cancer following radical pelvic surgery. Br J Obstet Gynaecol 1993; 100:73.
  4. http://seer.cancer.gov/csr/1975_2010/browse_csr.php?sectionSEL=5&pageSEL=sect_05_table.07.html (Accessed on March 12, 2014).
  5. http://www.seer.cancer.gov/statfacts/html/cervix.html (Accessed on September 07, 2011).
  6. Bisseling KC, Bekkers RL, Rome RM, Quinn MA. Treatment of microinvasive adenocarcinoma of the uterine cervix: a retrospective study and review of the literature. Gynecol Oncol 2007; 107:424.
  7. Wright JD, NathavithArana R, Lewin SN, et al. Fertility-conserving surgery for young women with stage IA1 cervical cancer: safety and access. Obstet Gynecol 2010; 115:585.
  8. Reade CJ, Eiriksson LR, Covens A. Surgery for early stage cervical cancer: how radical should it be? Gynecol Oncol 2013; 131:222.
  9. Spoozak L, Lewin SN, Burke WM, et al. Microinvasive adenocarcinoma of the cervix. Am J Obstet Gynecol 2012; 206:80.e1.
  10. Roy M, Plante M. Pregnancies after radical vaginal trachelectomy for early-stage cervical cancer. Am J Obstet Gynecol 1998; 179:1491.
  11. Sonoda Y, Abu-Rustum NR, Gemignani ML, et al. A fertility-sparing alternative to radical hysterectomy: how many patients may be eligible? Gynecol Oncol 2004; 95:534.
  12. Marchiole P, Benchaib M, Buenerd A, et al. Oncological safety of laparoscopic-assisted vaginal radical trachelectomy (LARVT or Dargent's operation): a comparative study with laparoscopic-assisted vaginal radical hysterectomy (LARVH). Gynecol Oncol 2007; 106:132.
  13. Beiner ME, Covens A. Surgery insight: radical vaginal trachelectomy as a method of fertility preservation for cervical cancer. Nat Clin Pract Oncol 2007; 4:353.
  14. Plante M. Evolution in fertility-preserving options for early-stage cervical cancer: radical trachelectomy, simple trachelectomy, neoadjuvant chemotherapy. Int J Gynecol Cancer 2013; 23:982.
  15. Shepherd JH. Cervical cancer. Best Pract Res Clin Obstet Gynaecol 2012; 26:293.
  16. Sahdev A, Sohaib SA, Wenaden AE, et al. The performance of magnetic resonance imaging in early cervical carcinoma: a long-term experience. Int J Gynecol Cancer 2007; 17:629.
  17. Peppercorn PD, Jeyarajah AR, Woolas R, et al. Role of MR imaging in the selection of patients with early cervical carcinoma for fertility-preserving surgery: initial experience. Radiology 1999; 212:395.
  18. Tanguay C, Plante M, Renaud MC, et al. Vaginal radical trachelectomy in the treatment of cervical cancer: the role of frozen section. Int J Gynecol Pathol 2004; 23:170.
  19. Park KJ, Soslow RA, Sonoda Y, et al. Frozen-section evaluation of cervical adenocarcinoma at time of radical trachelectomy: pathologic pitfalls and the application of an objective scoring system. Gynecol Oncol 2008; 110:316.
  20. Dargent D, Brun JL, Roy M. La trachélectomie élargie (T.E.). Une alternative à l'hystérectomie radicale dans le traitement des cancers infiltrants développés sur la face externe du col utérin. J Obstet Gynecol 1994; 2:292.
  21. Hauspy J, Beiner M, Harley I, et al. Sentinel lymph nodes in early stage cervical cancer. Gynecol Oncol 2007; 105:285.
  22. Plante M, Gregoire J, Renaud MC, Roy M. The vaginal radical trachelectomy: an update of a series of 125 cases and 106 pregnancies. Gynecol Oncol 2011; 121:290.
  23. Plante M, Renaud MC, Roy M. Vaginal radical trachelectomy. In: Atlas of procedures in gynecologic oncology, Levine DA, Barakat RR, Hoskins WJ (Eds), Martin Dunitz, 2003.
  24. Abu-Rustum NR, Sonoda Y, Black D, et al. Cystoscopic temporary ureteral catheterization during radical vaginal and abdominal trachelectomy. Gynecol Oncol 2006; 103:729.
  25. Bernardini M, Barrett J, Seaward G, Covens A. Pregnancy outcomes in patients after radical trachelectomy. Am J Obstet Gynecol 2003; 189:1378.
  26. Saling E. [Early total occlusion of os uteri prevent habitual abortion and premature deliveries (author's transl)]. Z Geburtshilfe Perinatol 1981; 185:259.
  27. Dargent D, Martin X, Sacchetoni A, Mathevet P. Laparoscopic vaginal radical trachelectomy: a treatment to preserve the fertility of cervical carcinoma patients. Cancer 2000; 88:1877.
  28. Jolley JA, Battista L, Wing DA. Management of pregnancy after radical trachelectomy: case reports and systematic review of the literature. Am J Perinatol 2007; 24:531.
  29. Plante M, Renaud MC, Hoskins IA, Roy M. Vaginal radical trachelectomy: a valuable fertility-preserving option in the management of early-stage cervical cancer. A series of 50 pregnancies and review of the literature. Gynecol Oncol 2005; 98:3.
  30. Sonoda Y, Chi DS, Carter J, et al. Initial experience with Dargent's operation: the radical vaginal trachelectomy. Gynecol Oncol 2008; 108:214.
  31. Alexander-Sefre F, Chee N, Spencer C, et al. Surgical morbidity associated with radical trachelectomy and radical hysterectomy. Gynecol Oncol 2006; 101:450.
  32. Boss EA, van Golde RJ, Beerendonk CC, Massuger LF. Pregnancy after radical trachelectomy: a real option? Gynecol Oncol 2005; 99:S152.
  33. Selo-Ojeme DO, Ind T, Shepherd JH. Isthmic stenosis following radical trachelectomy. J Obstet Gynaecol 2002; 22:327.
  34. Aust T, Herod J, Macdonald R, Gazvani R. Infertility after fertility-preserving surgery for cervical carcinoma: the next challenge for reproductive medicine? Hum Fertil (Camb) 2007; 10:21.
  35. Klemm P, Tozzi R, Köhler C, et al. Does radical trachelectomy influence uterine blood supply? Gynecol Oncol 2005; 96:283.
  36. Aust TR, Herod JJ, Gazvani R. Placement of a Malecot catheter to enable embryo transfer after radical trachelectomy. Fertil Steril 2005; 83:1842.
  37. Lanowska M, Mangler M, Spek A, et al. Radical vaginal trachelectomy (RVT) combined with laparoscopic lymphadenectomy: prospective study of 225 patients with early-stage cervical cancer. Int J Gynecol Cancer 2011; 21:1458.
  38. Lanowska M, Morawietz L, Sikora A, et al. Prevalence of lymph nodes in the parametrium of radical vaginal trachelectomy (RVT) specimen. Gynecol Oncol 2011; 121:298.
  39. Hertel H, Köhler C, Grund D, et al. Radical vaginal trachelectomy (RVT) combined with laparoscopic pelvic lymphadenectomy: prospective multicenter study of 100 patients with early cervical cancer. Gynecol Oncol 2006; 103:506.
  40. Beiner ME, Hauspy J, Rosen B, et al. Radical vaginal trachelectomy vs. radical hysterectomy for small early stage cervical cancer: a matched case-control study. Gynecol Oncol 2008; 110:168.
  41. Burnett AF. Radical trachelectomy with laparoscopic lymphadenectomy: review of oncologic and obstetrical outcomes. Curr Opin Obstet Gynecol 2006; 18:8.
  42. Covens A. Preserving fertility in early cervical cancer with radical trachlectomy. Contemp Ob Gyn 2003; 2:48.
  43. Mathevet P, Laszlo de Kaszon E, Dargent D. [Fertility preservation in early cervical cancer]. Gynecol Obstet Fertil 2003; 31:706.
  44. Marchiolé P, Buénerd A, Benchaib M, et al. Clinical significance of lympho vascular space involvement and lymph node micrometastases in early-stage cervical cancer: a retrospective case-control surgico-pathological study. Gynecol Oncol 2005; 97:727.
  45. Chernofsky MR, Felix JC, Muderspach LI, et al. Influence of quantity of lymph vascular space invasion on time to recurrence in women with early-stage squamous cancer of the cervix. Gynecol Oncol 2006; 100:288.
  46. Shepherd JH. Uterus-conserving surgery for invasive cervical cancer. Best Pract Res Clin Obstet Gynaecol 2005; 19:577.
  47. Sahdev A, Jones J, Shepherd JH, Reznek RH. MR imaging appearances of the female pelvis after trachelectomy. Radiographics 2005; 25:41.
  48. Singh N, Titmuss E, Chin Aleong J, et al. A review of post-trachelectomy isthmic and vaginal smear cytology. Cytopathology 2004; 15:97.
  49. Edey K, Denton K, Murdoch J. The role of cytological follow-up after radical vaginal trachelectomy for early-stage cervical cancer. Cytopathology 2014; 25:95.
  50. Carter J, Sonoda Y, Abu-Rustum NR. Reproductive concerns of women treated with radical trachelectomy for cervical cancer. Gynecol Oncol 2007; 105:13.
  51. Kay TA, Renninson JN, Shepherd JH, Taylor MJ. Successful pregnancy following radical trachelectomy and in vitro fertilisation with ovum donation. BJOG 2006; 113:965.
  52. Shepherd JH, Mould T, Oram DH. Radical trachelectomy in early stage carcinoma of the cervix: outcome as judged by recurrence and fertility rates. BJOG 2001; 108:882.
  53. Noyes N, Abu-Rustum NR, Ramirez PT, Plante M. Options in the management of fertility-related issues after radical trachelectomy in patients with early cervical cancer. Gynecol Oncol 2009; 114:117.
  54. Speiser D, Mangler M, Köhler C, et al. Fertility outcome after radical vaginal trachelectomy: a prospective study of 212 patients. Int J Gynecol Cancer 2011; 21:1635.
  55. Lavie O, Peer G, Sagi S, et al. The management of an early-missed abortion after radical trachelectomy--a case report and a review of the literature. Int J Gynecol Cancer 2006; 16:1688.
  56. Plante M, Roy M. Fertility-preserving options for cervical cancer. Oncology (Williston Park) 2006; 20:479.
  57. Smith JR, Boyle DC, Corless DJ, et al. Abdominal radical trachelectomy: a new surgical technique for the conservative management of cervical carcinoma. Br J Obstet Gynaecol 1997; 104:1196.
  58. Abu-Rustum NR, Sonoda Y, Black D, et al. Fertility-sparing radical abdominal trachelectomy for cervical carcinoma: technique and review of the literature. Gynecol Oncol 2006; 103:807.
  59. Pareja R, Rendón GJ, Sanz-Lomana CM, et al. Surgical, oncological, and obstetrical outcomes after abdominal radical trachelectomy - a systematic literature review. Gynecol Oncol 2013; 131:77.
  60. Testa R, Ramirez PT, Ferreyra H, et al. Abdominal radical trachelectomy: a safe and feasible option for fertility preservation in developing countries. J Low Genit Tract Dis 2013; 17:378.
  61. Einstein MH, Park KJ, Sonoda Y, et al. Radical vaginal versus abdominal trachelectomy for stage IB1 cervical cancer: a comparison of surgical and pathologic outcomes. Gynecol Oncol 2009; 112:73.
  62. Abu-Rustum NR, Su W, Levine DA, et al. Pediatric radical abdominal trachelectomy for cervical clear cell carcinoma: a novel surgical approach. Gynecol Oncol 2005; 97:296.
  63. Ungár L, Smith JR, Pálfalvi L, Del Priore G. Abdominal radical trachelectomy during pregnancy to preserve pregnancy and fertility. Obstet Gynecol 2006; 108:811.
  64. Wan XP, Yan Q, Xi XW, Cai B. Abdominal radical trachelectomy: two new surgical techniques for the conservation of uterine arteries. Int J Gynecol Cancer 2006; 16:1698.
  65. Cibula D, Slama J, Fischerova D. Update on abdominal radical trachelectomy. Gynecol Oncol 2008; 111:S111.
  66. Wethington SL, Cibula D, Duska LR, et al. An international series on abdominal radical trachelectomy: 101 patients and 28 pregnancies. Int J Gynecol Cancer 2012; 22:1251.
  67. Kim CH, Abu-Rustum NR, Chi DS, et al. Reproductive outcomes of patients undergoing radical trachelectomy for early-stage cervical cancer. Gynecol Oncol 2012; 125:585.
  68. Li J, Li Z, Wang H, et al. Radical abdominal trachelectomy for cervical malignancies: surgical, oncological and fertility outcomes in 62 patients. Gynecol Oncol 2011; 121:565.
  69. Nishio H, Fujii T, Sugiyama J, et al. Reproductive and obstetric outcomes after radical abdominal trachelectomy for early-stage cervical cancer in a series of 31 pregnancies. Hum Reprod 2013; 28:1793.
  70. Chen Y, Xu H, Zhang Q, et al. A fertility-preserving option in early cervical carcinoma: laparoscopy-assisted vaginal radical trachelectomy and pelvic lymphadenectomy. Eur J Obstet Gynecol Reprod Biol 2008; 136:90.
  71. Cibula D, Ungár L, Pálfalvi L, et al. Laparoscopic abdominal radical trachelectomy. Gynecol Oncol 2005; 97:707.
  72. Lee CL, Huang KG, Wang CJ, et al. Laparoscopic radical trachelectomy for stage Ib1 cervical cancer. J Am Assoc Gynecol Laparosc 2003; 10:111.
  73. Burnett AF, Stone PJ, Duckworth LA, Roman JJ. Robotic radical trachelectomy for preservation of fertility in early cervical cancer: case series and description of technique. J Minim Invasive Gynecol 2009; 16:569.
  74. Hong DG, Lee YS, Park NY, et al. Robotic uterine artery preservation and nerve-sparing radical trachelectomy with bilateral pelvic lymphadenectomy in early-stage cervical cancer. Int J Gynecol Cancer 2011; 21:391.
  75. Persson J, Imboden S, Reynisson P, et al. Reproducibility and accuracy of robot-assisted laparoscopic fertility sparing radical trachelectomy. Gynecol Oncol 2012; 127:484.
  76. Persson J, Kannisto P, Bossmar T. Robot-assisted abdominal laparoscopic radical trachelectomy. Gynecol Oncol 2008; 111:564.
  77. Geisler JP, Orr CJ, Manahan KJ. Robotically assisted total laparoscopic radical trachelectomy for fertility sparing in stage IB1 adenosarcoma of the cervix. J Laparoendosc Adv Surg Tech A 2008; 18:727.
  78. Chuang LT, Lerner DL, Liu CS, Nezhat FR. Fertility-sparing robotic-assisted radical trachelectomy and bilateral pelvic lymphadenectomy in early-stage cervical cancer. J Minim Invasive Gynecol 2008; 15:767.
  79. Nick AM, Frumovitz MM, Soliman PT, et al. Fertility sparing surgery for treatment of early-stage cervical cancer: open vs. robotic radical trachelectomy. Gynecol Oncol 2012; 124:276.
  80. Lee KY, Jun HA, Roh JW, Song JE. Successful twin pregnancy after vaginal radical trachelectomy using transabdominal cervicoisthmic cerclage. Am J Obstet Gynecol 2007; 197:e5.
  81. Alexopoulos E, Efkarpidis S, Fay TN, Williamson KM. Pregnancy following radical trachelectomy and pelvic lymphadenectomy for Stage I cervical adenocarcinoma. Acta Obstet Gynecol Scand 2002; 81:791.
  82. Petignat P, Stan C, Megevand E, Dargent D. Pregnancy after trachelectomy: a high-risk condition of preterm delivery. Report of a case and review of the literature. Gynecol Oncol 2004; 94:575.
  83. Wethington SL, Sonoda Y, Park KJ, et al. Expanding the indications for radical trachelectomy: a report on 29 patients with stage IB1 tumors measuring 2 to 4 centimeters. Int J Gynecol Cancer 2013; 23:1092.
  84. Lintner B, Saso S, Tarnai L, et al. Use of abdominal radical trachelectomy to treat cervical cancer greater than 2 cm in diameter. Int J Gynecol Cancer 2013; 23:1065.
  85. Li J, Wu X, Li X, Ju X. Abdominal radical trachelectomy: Is it safe for IB1 cervical cancer with tumors ≥ 2 cm? Gynecol Oncol 2013; 131:87.
  86. Landoni F, Parma G, Peiretti M, et al. Chemo-conization in early cervical cancer. Gynecol Oncol 2007; 107:S125.
  87. Kobayashi Y, Akiyama F, Hasumi K. A case of successful pregnancy after treatment of invasive cervical cancer with systemic chemotherapy and conization. Gynecol Oncol 2006; 100:213.
  88. Robova H, Pluta M, Hrehorcak M, et al. High-dose density chemotherapy followed by simple trachelectomy: full-term pregnancy. Int J Gynecol Cancer 2008; 18:1367.
  89. Maneo A, Chiari S, Bonazzi C, Mangioni C. Neoadjuvant chemotherapy and conservative surgery for stage IB1 cervical cancer. Gynecol Oncol 2008; 111:438.
  90. Plante M, Lau S, Brydon L, et al. Neoadjuvant chemotherapy followed by vaginal radical trachelectomy in bulky stage IB1 cervical cancer: case report. Gynecol Oncol 2006; 101:367.
  91. Marchiole P, Tigaud JD, Costantini S, et al. Neoadjuvant chemotherapy and vaginal radical trachelectomy for fertility-sparing treatment in women affected by cervical cancer (FIGO stage IB-IIA1). Gynecol Oncol 2011; 122:484.
  92. Vercellino GF, Piek JM, Schneider A, et al. Laparoscopic lymph node dissection should be performed before fertility preserving treatment of patients with cervical cancer. Gynecol Oncol 2012; 126:325.
  93. Covens A, Rosen B, Murphy J, et al. How important is removal of the parametrium at surgery for carcinoma of the cervix? Gynecol Oncol 2002; 84:145.
  94. Rob L, Charvat M, Robova H, et al. Less radical fertility-sparing surgery than radical trachelectomy in early cervical cancer. Int J Gynecol Cancer 2007; 17:304.
  95. Plante M, Gregoire J, Renaud MC, et al. Simple vaginal trachelectomy in early-stage low-risk cervical cancer: a pilot study of 16 cases and review of the literature. Int J Gynecol Cancer 2013; 23:916.
  96. Kyrgiou M, Koliopoulos G, Martin-Hirsch P, et al. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet 2006; 367:489.
  97. Klaritsch P, Reich O, Giuliani A, et al. Delivery outcome after cold-knife conization of the uterine cervix. Gynecol Oncol 2006; 103:604.
  98. http://clinicaltrials.gov/show/NCT01048853 (Accessed on March 12, 2014).
  99. http://clinicaltrials.gov/ct2/show/NCT01658930?term=NCT01658930&rank=1 (Accessed on March 12, 2014).
  100. Schmeler KM, Frumovitz M, Ramirez PT. Conservative management of early stage cervical cancer: is there a role for less radical surgery? Gynecol Oncol 2011; 120:321.