This article reviews the literature on fertility-sparing surgery in early cervical cancer. The article evaluates selection criteria, preoperative management and the most frequent surgical procedures used for preservation of fertility in cervical cancer. The article also analyzes oncological, fertility and pregnancy results. Oncological outcomes are not statistically different among single groups (vaginal radical trachelectomy, abdominal radical trachelectomy, simple trachelectomy or cone with or without neoadjuvant chemotherapy). Oncological results after fertility-sparing procedures in women with tumors smaller than 2 cm are comparable with women with the same risk factors after radical hysterectomy. Pregnancy following fertility-sparing surgery is associated with a variety of adverse pregnancy outcomes, especially second-trimester loss and preterm delivery. Less radical procedures (simple trachelectomy or cone with or without neoadjuvant chemotherapy) show statistically significant better pregnancy results. The pregnancy rate after abdominal radical trachelectomy was dramatically lower than in women treated with other types of fertility-sparing surgery. In the future, it will be necessary to optimize the technique and management of fertility-sparing surgery in order to attain good oncological results. Pregnancy outcomes should be given high priority. Fertility-sparing surgery is valuable for women who want to preserve their reproductive capability.

• MeSH
• adjuvantní chemoterapie MeSH
• biopsie sentinelové lymfatické uzliny MeSH
• diagnostické zobrazování MeSH
• dospělí MeSH
• gynekologické chirurgické výkony metody   MeSH
• hysterektomie škodlivé účinky   metody   MeSH
• kolposkopie MeSH
• kombinovaná terapie MeSH
• laparoskopie metody   MeSH
• lidé MeSH
• lokální recidiva nádoru prevence a kontrola   MeSH
• lymfatické metastázy MeSH
• nádory děložního čípku farmakoterapie   chirurgie   MeSH
• pooperační komplikace prevence a kontrola   MeSH
• pooperační péče MeSH
• spinocelulární karcinom sekundární   chirurgie   MeSH
• těhotenství MeSH
• úhrn těhotenství na počet žen v reprodukčním věku MeSH
• výsledek terapie MeSH
• ženská infertilita etiologie   prevence a kontrola   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

The purpose of the two pilot studies was to determine the feasibility and safety of using less-radical fertility-preserving surgery: laparoscopic lymphadenectomy with sentinel lymph node identification (SLNI) followed by a large cone or simple trachelectomy (LAP-I protocol) and the LAP-III protocol, which includes neoadjuvant chemotherapy (NAC). LAP-I: Forty women underwent laparoscopic SLNI, frozen-section analysis, and a complete pelvic lymphadenectomy as the first step of treatment. Seven days after final histopathological processing of dissected nodes, a large cone or simple vaginal trachelectomy was performed in patients with negative nodes. Nine women had a tumor larger than 20 mm, prompting the administration of three cycles of NAC before surgery. LAP-I: Six frozen sections were positive (15%). In these cases, a type III Wertheim was immediately performed. There were no false-negative SLNs. There was one central recurrence, but after chemoradiation therapy, there was no evidence of the disease 62 months post-treatment. Twenty-four of 32 women whose reproductive ability had been maintained tried to conceive. Of these 24 women, 17 became pregnant (71% pregnancy rate). Eleven mothers gave birth to 12 children (1 at 24 weeks, 1 at 34 weeks, 1 at 36 weeks, and 9 between 37 and 39 weeks). LAP-III: Nine patients were included. In 7 of these 9 women, reproductive ability was maintained, with 3 women becoming pregnant (1 full term and 2 ongoing). SLNI improves safety in fertility-sparing surgery. Large cone or simple trachelectomy combined with laparoscopic pelvic lymphadenectomy can be a feasible method that yields a high, successful pregnancy rate. NAC followed by fertility-sparing surgery is an experimental alternative treatment for larger tumors.

• MeSH
• adjuvantní chemoterapie MeSH
• biopsie sentinelové lymfatické uzliny MeSH
• dospělí MeSH
• fertilita * MeSH
• gynekologické chirurgické výkony metody   MeSH
• lidé MeSH
• lymfadenektomie MeSH
• nádory děložního čípku farmakoterapie   patologie   chirurgie   MeSH
• pilotní projekty MeSH
• staging nádorů MeSH
• těhotenství MeSH
• výsledek těhotenství MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH