This review sought to evaluate the current literature on reproductive and oncologic outcomes after fertility-sparing surgery for early stage cervical cancer (stage IA1-IB1) including cold-knife conization/simple trachelectomy, vaginal radical trachelectomy, abdominal radical trachelectomy, and laparoscopic radical trachelectomy with or without robotic assistance. A systematic review using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist to evaluate the current literature on fertility-sparing surgery for early stage cervical cancer and its subsequent clinical pregnancy rate, reproductive outcomes, and cancer recurrence was performed. Sixty-five studies were included encompassing 3,044 patients who underwent fertility-sparing surgery, including 1,047 pregnancies with reported reproductive outcomes. The mean clinical pregnancy rate of patients trying to conceive was 55.4%, with the highest clinical pregnancy rate after vaginal radical trachelectomy (67.5%). The mean live-birth rate was 67.9% in our study. Twenty percent of pregnancies after fertility-sparing surgery required assisted reproductive technology. The mean cancer recurrence rate was 3.2%, and the cancer death rate was 0.6% after a median follow-up period of 39.7 months with no statistically significant difference across surgical approaches. Fertility-sparing surgery is a reasonable alternative to traditional radical hysterectomy for early-stage cervical cancer in women desiring fertility preservation. Vaginal radical trachelectomy had the highest clinical pregnancy rate, and minimally invasive approaches to fertility-sparing surgery had equivalent oncologic outcomes compared with an abdominal approach. The results of our study allow for appropriate patient counseling preoperatively and highlight the importance of a multidisciplinary approach to achieve the best outcomes for each patient.

中文翻译：

---

早期宫颈癌保留生育能力手术后的生殖和肿瘤学结果：系统评价

本综述旨在评估目前关于早期宫颈癌（IA1-IB1 期）保留生育能力手术后生殖和肿瘤学结果的文献，包括冷刀锥切术/简单宫颈切除术、阴道根治性宫颈切除术、腹部根治性宫颈切除术和腹腔镜根治性宫颈切除术有或没有机器人协助。使用系统评价和荟萃分析 (PRISMA) 清单的首选报告项目进行了系统评价，以评估当前关于早期宫颈癌保留生育手术及其后续临床妊娠率、生殖结果和癌症复发的文献。纳入了 65 项研究，包括 3,044 名接受保留生育手术的患者，其中 1,047 名妊娠报告了生育结果。尝试受孕患者的平均临床妊娠率为55.4%，其中阴道根治性宫颈切除术的临床妊娠率最高（67.5%）。在我们的研究中，平均活产率为 67.9%。保留生育能力手术后 20% 的怀孕需要辅助生殖技术。在中位随访 39.7 个月后，平均癌症复发率为 3.2%，癌症死亡率为 0.6%，不同手术方法之间无统计学差异。对于希望保留生育能力的早期宫颈癌女性，保留生育能力手术是传统根治性子宫切除术的合理替代方案。阴道根治术的临床妊娠率最高，与腹部手术相比，保留生育能力手术的微创手术具有相同的肿瘤学结果。我们的研究结果允许在术前进行适当的患者咨询，并强调多学科方法对为每位患者实现最佳结果的重要性。