Department of Gynecologic Oncology (Drs. Kuznicki, Chambers, Horowitz, and Crean-Tate) and Obstetrics and Gynecology (Drs. Morton and Son), Women's Health Institute, (Dr. Rose).
Library Services Education Institute (Ms. Hackett), Cleveland Clinic, Cleveland, Ohio.
J Minim Invasive Gynecol. 2021 Mar;28(3):513-526.e1. doi: 10.1016/j.jmig.2020.10.013. Epub 2020 Oct 24.
This systematic review aimed to evaluate oncologic and reproductive outcomes after fertility-sparing surgery (FSS) for early-stage cervical cancer (early CC).
Ovid MEDLINE, Ovid EMBASE, and Cochrane CENTRAL were searched from 1980 to the present using Medical Subject Headings terms; other controlled vocabulary terms; and keywords related to fertility, cervical cancer, and surgical techniques.
A total of 2415 studies were screened, with 53 studies included. Studies reporting recurrences with a median follow-up of 12 months in early CC (International Federation of Gynecology and Obstetrics 2009 stages IA with lymphovascular space invasion, IB, or IIA) of traditional histologic type undergoing FSS were included.
TABULATION, INTEGRATION, AND RESULTS: The studies were grouped by intervention, including vaginal radical trachelectomy (VRT), abdominal radical trachelectomy (ART), minimally invasive radical trachelectomy (MIS-RT), and conization or simple trachelectomy (ST), and studies involving neoadjuvant chemotherapy (NACT). Combined rates of recurrence (RR), cancer death (CDR), pregnancy (PR), and live birth (LBR) were calculated per procedure on the basis of all included studies that reported outcomes on that procedure. The results were as follows: VRT: RR 4%, CDR 1.7%, PR 49.4%, and LBR 65.0% ART: RR 3.9%, CDR 1.4%, PR 43.2%, and LBR 44.0% MIS-RT: RR 4.2%, CDR 0.7%, PR 36.2%, and LBR 57.1% Cone or ST: RR 4.2%, CDR 0.8%, PR 55.1%, and LBR 71.9% NACT: RR 7.5% and CDR 2.0% CONCLUSION: FSS of early CC with VRT, ART, or MIS-RT have comparable oncologic outcomes in carefully selected patients, with reproductive outcomes favoring VRT. Data on nonradical FSS with cone or ST are less robust but support similar oncologic outcomes to radical trachelectomy with fewer reproductive complications. NACT in this setting requires more investigation before routine implementation into practice.
本系统评价旨在评估早期宫颈癌（早期 CC）保留生育功能手术（FSS）后的肿瘤学和生殖结局。
从 1980 年至今，使用医学主题词（MeSH）在 Ovid MEDLINE、Ovid EMBASE 和 Cochrane CENTRAL 进行检索；还使用了其他受控词汇和与生育、宫颈癌和手术技术相关的关键词进行检索。
共筛选了 2415 项研究，纳入了 53 项研究。纳入的研究报告了复发情况，中位随访时间为 12 个月，纳入的是传统组织学类型的早期 CC（国际妇产科联合会 2009 年分期为 IA 伴血管淋巴管间隙浸润、IB 或 IIA）患者，行 FSS。
列表、整合和结果：根据干预措施对研究进行分组，包括阴道根治性子宫颈切除术（VRT）、腹式根治性子宫颈切除术（ART）、微创根治性子宫颈切除术（MIS-RT）和锥形切除术或简单子宫颈切除术（ST），以及涉及新辅助化疗（NACT）的研究。根据报告该手术结果的所有纳入研究，计算了每种手术的复发率（RR）、癌症死亡率（CDR）、妊娠率（PR）和活产率（LBR）的综合率。结果如下：VRT：RR 4%，CDR 1.7%，PR 49.4%，LBR 65.0%；ART：RR 3.9%，CDR 1.4%，PR 43.2%，LBR 44.0%；MIS-RT：RR 4.2%，CDR 0.7%，PR 36.2%，LBR 57.1%；锥形切除术或 ST：RR 4.2%，CDR 0.8%，PR 55.1%，LBR 71.9%；NACT：RR 7.5%，CDR 2.0%。
在精心挑选的患者中，VRT、ART 或 MIS-RT 治疗早期 CC 的 FSS 具有可比较的肿瘤学结局，而生殖结局有利于 VRT。锥形切除术或 ST 的非根治性 FSS 的相关数据不太可靠，但支持与根治性子宫颈切除术相似的肿瘤学结局，且生殖并发症较少。在这种情况下，NACT 需要更多的研究，然后才能在常规实践中实施。
