Global Perspective on Fertility-Sparing Surgical Oncology in Gynaecology: A Narrative Literature Review

Fertility-sparing surgery (FSS) has become a significant therapeutic option for young women with early-stage gynaecologic malignancies, aiming to balance effective cancer treatment with preservation of reproductive potential. However, the results are different based on the type of tumour, method of treatment, and mechanism of patient selection. This narrative literature review aimed to synthesise the current evidence on FSS oncology in gynaecology worldwide. The literature search included predominantly retrospective cohort studies, along with prospective cohort, cross-sectional, case-control, and randomised controlled studies, published between 1st January 2015 and 31st March 2026. The outcomes assessed were fertility preservation rates, pregnancy outcomes, live births, obstetric complications, oncologic outcomes (overall survival and recurrence), and prognostic factors affecting treatment success. Fertility preservation rates ranged from 55% to 100%, with rates exceeding 75% among patients with earlier-stage disease. Pregnancy outcomes were optimised in selected patients through the use of assisted reproductive technology (ART), including in vitro fertilisation (IVF). Conception occurred either spontaneously or through ART, with conception rates varying among women who attempted pregnancy. The live birth rates were between 20% and over 80%, but preterm delivery and obstetric complications were common. Across most included studies, the five-year overall survival rate exceeded 90% among patients with early-stage disease. Nevertheless, recurrence rates ranged from 1% to >20%, depending on tumour characteristics. Tumour size exceeding 2 cm, lymphovascular space invasion, and high-stage disease were consistently identified as significant predictors of recurrence and low disease-free survival. Current evidence suggests that FSS may be a safe and effective treatment option for carefully selected patients with early-stage gynaecological cancers while preserving reproductive potential. Fertility and survival outcomes should be optimised with the use of standardised protocols and long-term follow-up.