Pregnancy And Oncologyic Outcomes With Different Surgical Procedures For Fertility Preservation In Early Cervical Cancer

Background and Objective:Maternity preserving surgery for gynecological tumors has always been a major problem for gynecological oncologists,and is also one of the hottest topics in recent years^[1].The incidence of cervical cancer is correlated with the regional economic level,One study has reported that 85%of cervical cancer cases in the world are found in developing countries.Following improvement in the widespread use of cervical cancer screening technology,this condition is being increasingly detected in young patients and in those with early stages of this disease.According to previous research data,age≤40 years,cervical squamous cell carcinoma or adenocarcinoma confifirmed by pathology,nulliparous or parous with child-bearing requirementno infertility or other diseases that are diffificult to treatclinical stage IAl to stage IIA1（focal diameter>2 cm and<4 cm,which shrank after intravenous chemotherapy）,Fertility preserving surgery is feasible.Fertility preserving surgery for cervical cancer includes:cervical conization,cervical resection,and extensive cervical resection,However,the choice of surgical methods for different clinical stages and pathological characteristics is still uncertain.The reported data on tumor outcome and fertility outcome of different fertility preserving surgery methods are very limited.Therefore,we expect to retrospectively analyze the recurrence related factors of patients who have undergone cervical cancer care operations in our center,so as to screen and optimize the surgical indications and maximize the avoidance of tumor recurrence and metastasis factors.To explore the appropriate management strategy for fertility preservation in different stage and risk of early cervical cancers.Methods:The data of fertility preservation for early cervical cancerwere collected from January2010 to December 2019 in the First Affiliated Hospital of Army Military Medical University.All patient were follow-up regularly after operation.The patients were divided into three groups according to surgical methods:extensive cervical with pelvic lymph node resection group,simple cervical resection group,cervical conical resection group.The clinicopathological factor and outcome were analyzedretrospectively.The pregnancy rate（patients with fertility intention）and long-term complications were observed,as well as the incidence of cervical stenosis in simultaneous cervical ring ligature during surgery.Results:1.A total of 60 patients were enrolled.There were cervical squamous carcinoma（57）and cervical adenocarcinoma（3）,34 patients had stage IA1,1 had stage IA2,24 had stage IBI,and 1 had stage IIA1（FIGO 2018）.2.A total of 60 patients were enrolled,6.7%（4/60）of the patients had recurrence,and the death rate was 5.0%（3/60）.3.There was no recurrence in the cervical resection group.The recurrence rate in the extensive cervical resection group was 10.7%while the cervical conical resection group was 6.7%,no difference between the two groups.The median follow-up time was 27.3months.4.5-year free disease rate（DFS）in patients with pepele who was Fertility preserving patients with early cervical cancer is 93.3%（56/60）,overall survival（OS）95%（57/60）;The Fertility preserving patients with early cervical cancer were divided into three groups,cervical conical resection group DFS 96%（24/25）,OS 96%（24/25）,extensive cervical with pelvic lymph node resection group DFS 89.3%（25/28）,OS 92.9%（26/28）.5.The main recurrence factors were IB1 stage with deep myometrial invasion.Multivariate COX regression analysis in the recurrence group:Myometrial invasion is the risk factor of recurrence,and the risk of recurrence in deep muscle invasion is 29.381 times that in superficial infiltration（OR=29.381（95%CI:3.042-283.755）,P=0.003）.6.Among the 23 patients who planned pregnancy after treatment,6 were pregnant（26.1%）,including 3 full-term delivery.7.Long-term postoperativecomplication were severe cervical adhesion and stenosis.4cases（17.4%,4/23）in ligation treatment and 2 cases（5.4%,2/37）in un-ligation,There was no significant difference in the incidence between the two groups（P=0.191）.Conclusion:1.Deep myometrial invasion is a risk factor for recurrence of early cervical cancer after fertility preserving surgery.2.Stage IB1 with deep myometrial invasion is a independent risk factor for recurrence of early cervical cancer after fertility preserving surgery.3.The common long-term complications were cervical adhesion/cervix narrow after fertility preserving surgery for early cervical cancer.4.The optimal fertility preservation surgery should be adopted for patientswith early cervical cancer according to different risks and stages.To reduce the recurrence and metastasis,those patient with intermediate risk factors should be accepted postoperative adjuvant therapy.