Chirurgie des cancers gynécologiques et préservation de la fertilité

For gynaecological cancers, even at an early stage, the standard treatment is “radical excision” involving hysterectomy (radical or not) with bilateral salpingo-oophorectomy. But for young patients with early stage disease, many recent studies have focused on preservation of subsequent fertility by keeping at least one ovary and the uterus. The main objective of this fertility-sparing surgery is to preserve fertility, if this can be accomplished without increasing the oncological risks. Whether the initial site of the cancer is the cervix, uterine fundus or ovary, the oncologic validation of fertility-sparing treatment requires several evaluation criteria: a rigorous clinical, radiological and surgical staging to verify that the pathology is truly at an early initial stage; expert pathologic interpretation of biopsy specimens to validate the histological criteria of “good prognosis”; provision of complete and understandable patient education verifying the true objectives for this fertility-sparing treatment (whose intent is to retain a potential for subsequent fertility without guaranteeing it) and provision of an explanation of the oncological constraints and implications of fertility-sparing surgery in the event of a possible pregnancy. As always in oncology, this strategy demands teamwork requiring successive discussions with the patient and spouse and thorough discussion of the oncological safety of this fertility-sparing strategy in multidisciplinary consultation meetings before “giving a green light”.