Radical trachelectomy in Brazil: a multi-institutional review on fertility preservation and oncologic outcomes

Fertility preservation has become an increasingly important goal in the management of young women with early-stage cervical cancer. Radical trachelectomy is an established fertility-sparing procedure with favorable oncologic and reproductive outcomes; however, evidence from low- and middle-income countries remains limited. This study aimed to evaluate perioperative, pathologic, oncologic, reproductive, and obstetric outcomes of radical trachelectomy in a large multi-center Brazilian cohort.

This retrospective multi-center study included patients with an initial International Federation of Gynecology and Obstetrics 2018 stage IA1-IB3 cervical cancer who underwent radical trachelectomy between January 2010 and April 2026 at 19 Brazilian centers. Eligible histologic sub-types included squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma. Demographic, surgical, pathological, oncologic, and reproductive data were collected from medical records. Comparisons between groups were performed using chi-square, Fisher exact, likelihood ratio, or Mann-Whitney tests, as appropriate. Recurrence-free survival was estimated using the Kaplan-Meier method and compared using the log-rank test. Statistical significance was set at p <.05.

A total of 141 women underwent radical trachelectomy. Median age was 32 years (Interquartile range, 29 to 35), and most patients had International Federation of Gynecology and Obstetrics 2018 stage IB1 disease (52.5%). Nodal assessment was performed in 98.6% of cases, with lymph node metastases identified in 6.5% (9/139). Parametrial involvement was observed in 2.1% (3/140) of patients. Most procedures were performed using a minimally invasive approach (83.7%). Adjuvant treatment was required in 9.9% of cases. After a median follow-up of 49.4 months, the 5-year recurrence-free survival rate (calculated from the date of surgery) was 91.3%, and no statistically significant difference was observed between patients undergoing minimally invasive and open surgery (p =.873). Cancer-related mortality was 2.8% (4/141). Among 51 women attempting conception, 23 (45.1%) achieved pregnancy, resulting in 32 pregnancies and 18 live births.

Radical trachelectomy provided favorable oncologic outcomes while preserving reproductive potential in selected women with early-stage cervical cancer. The low rates of recurrence, nodal metastasis, and parametrial involvement observed in this study are consistent with contemporary evidence supporting less radical surgical approaches in carefully selected patients.