Feasibility And Safety Analysis Of Cold Knife Conization And Loop Electro Surgical As Fertility-sparing Procedures In Women With Early-Stage Cervical Cancer

BackgroundCervical cancer is the second most popular cancer among women in developing countries and the seventh most popular cancer in developed countries.The incidence of cervical cancer is rising in China,and it is showing a trend of lower age.About 40%of patients with early-stage cervical cancer are of reproductive age,and mortality rates have risen in the 45 to 50-year-old population.According to National Comprehensive Cancer Network(NCCN 2019)guidelines,the standard treatment for stage IA1 cervical cancer is extrafascial hysterectomyt pelvic lymphadenectomy(PELN),and patients with stage IA2-IB1 should undergo extensive or modified extensive hysterectomy plus pelvic lymphadenectomy.Patients are considered to be relatively safe to undergo fertility-preserving surgery with early-stage cervical cancer(IA1-IB2).Most scholars recommend radical trachelectomy and pelvic lymphadenectomy or sentinel lymph node(SLN)biopsy at the same time for the fertility-preserving surgery,but this procedure has a large negative impact on pregnancy rate and pregnancy outcome,so it is important to reduce the trauma of surgery and improve the outcome of pregnancy without reducing the effectiveness of tumor treatment.Here,we explore the effects of cold knife conical resection(CKC)and loop electro-surgical(LEEP)on the safety of treatment of patients with early cervical cancer and the impact on pregnancy.MethodsWe used the medical record information retrieval system of Qilu hospital to retrieve cases,and retrospectively analyzed the case information of patients diagnosed with early-stage cervical cancer(IA1-IB1,re-staging according to FIGO 2018)from January 1,2010 to July 1,2019.The patients were divided into the fertility group and the control group according to their fertility needs and surgical methods.The inclusion criteria of the fertility group were:age<40 years old,fertility requirement without infertility factors,squamous cell carcinoma or adenocarcinoma,fertility preserving surgery(CKC/LEEP±sentinel lymph node biopsy),and no lymph node metastasis was confirmed by pathology.The inclusion criteria for the control group were:age<40 years,no fertility requirements,squamous cell carcinoma or adenocarcinoma,radical surgery after CKC/LEEP(extrafascial hysterectomy,modified extensive hysterectomy,or extensive hysterectomy±pelvic lymphadenectomy or sentinel lymph node biopsy)and postoperative pathology confirmed no lymph node metastasis.The pregnancy status of patients with fertility preservation was followed up by outpatient review,telephone follow-up and medical records information retrieval system of Qilu hospital of Shandong university.The start time of follow-up was the time of first diagnosis,and the end time of follow-up was 2019.09.17 or until the death of the patient.The follow-up information includes:1.Outpatient review:clinical evaluation,tumor markers(such as CA-125,CA-199,SCC),cervical TCT smear,HPV-DNA monitoring and colposcopy;2.Telephone follow-up:postoperative supplementary treatment,postoperative complication,recurrence and recurrence time,treatment plan and treatment result and death;3.For the fertility group,the time of pregnancy after surgery,pregnancy outcomes and pregnancy complications were additionally collected.4.Follow-up frequency:review was conducted every 3 months for the first two years after surgery,and every 6 months for the following 3 years.SPSS statistical software was used for data processing and statistical analysis,and chi-square test analysis was used for comparison between the two groups.Age,pregnancy history,preoperative TCT results,preoperative biopsy results,FIGO stage,depth of muscular infiltration,lymphatic interstitial infiltration,and survival information of the two groups were compared.ResultsA total of 66 patients were included in the fertility group.The age range was 21-40 years,and the average age was 32.24±4.28 years.A total of 44 patients were included in the control group,ranging in age from 22 to 40 years,with an average age of 33.18±4.50 years.There were no statistical differences between the two groups in terms of age,FIGO stage,pathological type,LVSI,preoperative TCT and preoperative biopsy results.The median follow-up time was 23 months(3-110 months).During follow-up,a patient with stage IB1 of cervical adenocarcinoma was found pulmonary and distant lymph node metastases at the time of 38 months after CKC,and subsequently died of multiple metastases at the time of 42 months after CKC.The five-year progression-free survival rate of the fertility group was 98.53%,and the five-year survival rate was 98.53%.The median follow-up time of the control group was 35 months(3-104 months).In control group,a patient with stage IA2 squamous cervical cancer recurred at 6 months after operation,and was treated with docetaxel and cisplatin intravenous chemotherapy and achieved partial remission.The five-year progression-free survival rate of the control group was 97.73%,and the five-year survival rate was 100%.In the fertility group,a total of 30 patients(53.33%)try to get pregnant after the operation,and 16(53.33%)cases had a total of 16 pregnancies,including 8(50%)cases of early pregnancy abortion,1(6.25%)case of premature delivery,and 7(43.75%)cases of full-term delivery.The average gestation time was 14.94 months(2-33 months)after the operation.Three patients underwent laparoscopic cervical cerclage during the operation,7 and 20 months after the operation,respectively.Among them,1 patient had a second-trimester abortion due to cervical insufficiency before the cervical annulus ligation,and the 3 patients were not pregnant during the follow-up.ConclusionFor patients with cervical cancer in early stage(IA2-IB1,FIGO 2018)who have fertility requirements,CKC or LEEP is safe with high success rate of pregnancy after full assessment of no lymph node metastasis before and during surgery.