Recent research suggests that fertility-sparing surgery, which avoids hysterectomy, yields similar outcomes to traditional radical surgery among women with small tumors in early-stage cervical cancer.
Current guidelines typically recommend standard surgery, involving hysterectomy, for stage I cervical cancer with tumors larger than two centimeters. This procedure renders women unable to carry a pregnancy. However, the impact on life expectancy of fertility-sparing surgery, where only the cervix is removed, particularly in cases of larger tumors, has been uncertain.
Researchers from the University of Texas MD Anderson Cancer Centre in Houston conducted a study comparing the outcomes of different surgical approaches. Published in the American Journal of Obstetrics and Gynaecology, their findings challenge existing guidelines by suggesting that fertility-sparing surgery may not lead to inferior life expectancy compared to standard surgery, even for tumors up to four centimeters in size.
The study analyzed data from the National Cancer Database spanning from 2006 to 2018. It focused on women under 45 years old diagnosed with stage I cervical cancer and tumors up to four centimeters in width. Among the 1,794 patients included, evenly split between those who underwent fertility-sparing surgery and standard hysterectomy, the five-year survival rates were comparable across all tumor sizes studied.
Although the precision of the data was higher for smaller tumors due to fewer cases of larger tumors treated with fertility-sparing surgery, the study found no significant difference in survival rates. For tumors one centimeter in size, the difference in life expectancy was minimal, while larger tumors showed potential variations in months.
While current US and European guidelines discourage fertility-sparing surgery for tumors larger than two centimeters, the researchers argue that this threshold may be arbitrary. They point out that existing guidelines are based on limited evidence, often excluding patients with larger tumors.
Based on their findings, the authors advocate for expanding the eligibility criteria for fertility-sparing surgery, suggesting it could be a viable option for select patients with tumors up to four centimeters in size. This could potentially offer more women the opportunity to preserve fertility without compromising their survival outcomes.
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