Brazilian Society of Surgical Oncology consensus on fertility-sparing surgery for cervical cancer

Afiliação 

(1)    AC Camargo Cancer Center, São Paulo, Brazil.

(2)    Erasto Gaertner Hospital, Curitiba, Brazil.

(3)    National Cancer Institute, Rio de Janeiro, Brazil.

(4)    Beneficencia Portuguesa de São Paulo, São Paulo, Brazil.

(5)    Aristides Maltez Hospital, Salvador, Brazil.

(6)    ISPON, Ponta Grossa, Brazil.

(7)    Barretos Cancer Hospital, Barretos, Brazil.

(8)    Ophir Loyola Hospital, Belem, Brazil.

(9)    Juiz de Fora Federal University, Juiz de Fora, Brazil.

(10)Sao Paulo State Institute of Cancer, Sao Paulo, Brazil.

(11)Oncoradium Rede de Oncologia, Imperatriz, Brazil.

(12)Professor Edgard Santos University Hospital, Salvador, Brazil.

(13)Centro de Oncologia do Paraná, Curitiba, Brazil.

(14)Brazilian Institute of Cancer, Sao Paulo, Brazil.

Resumo

Objective: Several controversies remain on conservative management of cervical cancer. Our aim was to develop a consensus recommendation on important and novel topics of fertility-sparing treatment of cervical cancer. Methods: The consensus was sponsored by the Brazilian Society of Surgical Oncology (BSSO) from March 2020 to September 2020 and included a multidisciplinary team of 55 specialists. A total of 21 questions were addressed and they were assigned to specialists' groups that reviewed the literature and drafted preliminary recommendations. Further, the coordinators evaluated the recommendations that were classified by the level of evidence, and finally, they were voted by all participants. Results: The questions included controversial topics on tumor assessment, surgical treatment, and surveillance in conservative management of cervical cancer. The two topics with lower agreement rates were the role of minimally invasive approach in radical trachelectomy and parametrial preservation. Additionally, only three recommendations had <90% of agreement (fertility preservation in Stage Ib2, anti-stenosis device, and uterine transposition). Conclusions: As very few clinical trials have been developed in surgery for cervical cancer, most recommendations were supported by low levels of evidence. We addressed important and novel topics in conservative management of cervical cancer and our study may contribute to literature.