Oncologic outcomes and the impact of minimally invasive surgery in early-stage cervical cancer patients undergoing radical trachelectomy: A retrospective multicenter cohort study from the Korean Gynecologic Oncology Group Study (KGOG 1048)

Abstract

Objective: This study aimed to investigate long-term oncologic outcomes, assess the impact of minimally invasive surgery (MIS) in patients with early-stage cervical cancer who underwent radical trachelectomy, and evaluate postoperative fertility outcomes. Methods: This study analyzed 283 patients with early-stage cervical cancer who underwent radical trachelectomy between 2004 and 2022. Patients who received neoadjuvant chemotherapy or were converted to radical hysterectomy were excluded. Clinicopathological and surgical data were collected; survival outcomes were evaluated using Cox regression analysis. Results: The median follow-up was 59.6 months (range, 4.3-198.6). The median tumor size was 16.0 mm (range, 2.0-70.0). Disease-free survival (DFS) and overall survival (OS) rates were 88.3% and 96.1%, respectively; the recurrence and mortality rates were 11.7% and 3.9%, respectively. Among tumors <2 cm in size, the DFS and OS rates were 90.5% and 98.1%, respectively. Preoperative loop electrosurgical excision procedure (LEEP) was a protective factor (HR 0.341, 95% CI 0.161-0.718; p = 0.005), whereas lymphovascular space invasion (LVSI) (HR 2.191, 95% CI 1.033-4.647; p = 0.041) and vaginal extension (HR 3.108, 95% CI 1.130-8.550; p = 0.028) were independent adverse prognostic factors. MIS was not adversely associated with DFS (p = 0.118) or OS (p = 0.840). Fertility outcomes were available for 59 patients; 62.7% of them conceived (n = 37) and 56.8% of them delivered live births (n = 21). Preterm births occurred in 52.4% of known deliveries. Conclusion: Radical trachelectomy demonstrated favorable oncologic and fertility outcomes in early-stage cervical cancer, especially in tumors <2 cm in size. MIS did not compromise survival, supporting radical trachelectomy as a feasible fertility-preserving option for appropriately selected patients. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.