简单或根治性子宫颈切除术对于诊断为≤2cm宫颈癌的患者被接受作为保存生育能力的治疗方法。对于较大肿瘤的患者，保存生育概念被认为是实验性的。我们的研究旨在介绍经腹腔镜盆腔淋巴结清扫术结合新辅助化疗和随后的阴式根治性子宫颈切除术的肿瘤学和生育结局。这些手术是在柏林自由大学查奇瑞特大学和汉堡阿斯克利皮奥斯医院这两家医疗中心中，于2006年2月至2020年6月间，在诊断为直径大于2cm的宫颈癌患者中进行的。我们回顾性分析了根据国际妇产科联合会（FIGO）2018年分类系统评估为IB2、IB3或IIA1期的宫颈癌患者的人口统计学、组织学、生育和随访数据。这些患者在2006年2月至2020年6月期间，在柏林自由大学查奇瑞特大学和汉堡阿斯克利皮奥斯医院接受盆腔淋巴结清扫术、新辅助化疗和阴式根治性子宫颈切除术。共有31名患者（平均年龄29.5岁，范围为26-40岁）在淋巴结明确无肿瘤的情况下接受新辅助化疗后进行了阴式根治性子宫颈切除术。其中26名患者（84%）为无产妇。在这31名患者中，初始肿瘤分期为FIGO 2018年IB2期的27例、IB3期的3例和IIA1期的1例。淋巴结清扫术在除一例（岛屿式）外的所有患者中均已完成，盆腔淋巴结数目的中位数为33个（范围为11-47个）。新辅助化疗方案包括17例患者接受紫杉醇、异环化石蜡和顺铂两个疗程；8例患者接受紫杉醇、异环化石蜡和顺铂三个疗程；4例患者接受紫杉醇和顺铂两个疗程；1例患者接受顺铂单独一个疗程；1例患者接受紫杉醇和顺铂两个疗程，随后接受紫杉醇、异环化石蜡和顺铂两个疗程。17个标本（55%）中存在组织学上确定为残余肿瘤。新辅助化疗后残余肿瘤的中位数大小为12mm（范围为1-60mm）。27例患者（87%）的生育能力得以保留；其中2例患者在阴式根治性子宫颈切除术后接受了辅助化放疗，因为存在高危组织学特征；另外2例患者在新辅助化疗后接受了根治性子宫切除术并接受辅助化放疗。在18例患者（67%）寻求生育的情况下，有13例（72%）成功怀孕。共有10名妇女诞下12个活产儿，胎儿体重中位数为2490克（范围为1640-3560克），并出现5例流产。在中位随访时间为94.5个月（范围为6-183个月）后，发现3例疾病复发（11.1%），1例患者（3.7%）死于疾病。对于寻求生育的宫颈癌>2cm患者，经新辅助化疗后进行根治性子宫颈切除术可以提供健康婴儿的怀孕机会，在出院时的健康婴儿怀孕比率为10/18名患者（55%）。相比于文献报道中直径不超过2cm的宫颈癌患者接受根治性子宫颈切除术，这种保存生育策略与更高的复发和死亡率有关。© IGCS and ESGO 2023. 未经商业复用。请查看权利和权限。由BMJ出版。

Simple or radical trachelectomy are accepted fertility sparing therapies for patients diagnosed with cervical cancer ≤2 cm. In patients with larger tumors a fertility sparing concept is considered experimental. The aim of our study is to present oncological and fertility outcomes of laparoscopic pelvic lymphadenectomy followed by neoadjuvant chemotherapy and subsequent radical vaginal trachelectomy. These procedures were performed in two centers in patients diagnosed with cervical cancer of diameter >2 cm.We retrospectively analyzed the demographic, histological, fertility and follow-up data of all patients with cervical cancer assessed as stage IB2, IB3 or IIA1 under the International Federation of Gynecology and Obstetrics (FIGO) 2018 system. These patients had undergone pelvic lymphadenectomy, followed by neoadjuvant chemotherapy and radical vaginal trachelectomy between February 2006 and June 2020 at Charité University Berlin and Asklepios Hospital, Hamburg.A total of 31 patients (mean age 29.5 years, range; 26-40) underwent neoadjuvant chemotherapy followed by radical vaginal trachelectomy in case of proven tumor-free lymph nodes. Twenty-six (84%) of these patients were nulliparous. Across all 31 patients, the initial tumor stages were FIGO 2018 stage IB2 (n=27), IB3 (n=3) and IIA1 (n=1).Lymphadenectomy was completed in all but one patient (sentinel) with a median of 33 (range; 11-47) pelvic lymph nodes. The neoadjuvant chemotherapy regimen was two cycles of paclitaxel, ifosfamide and cisplatin in 17 patients; three cycles of paclitaxel, ifosfamide and cisplatin in eight patients; two cycles of paclitaxel and cisplatin in four patients; two cylces cisplatin monoagent in one patient; and two cycles of paclitaxel and cisplatin followed by two cycles of paclitaxel, ifosfamide and cisplatin in one patient. Residual tumor was histologically confirmed in 17 specimens (55%). The median residual tumor size following neoadjuvant chemotherapy was 12 mm (range; 1-60). Fertility could be preserved in 27 patients (87%); two patients underwent adjuvant chemoradiation after radical vaginal trachelectomy due to high-risk histological features; two other patients underwent radical hysterectomy with adjuvant chemoradiation therapy following neoadjuvant chemotherapy. Of 18 (67%) patients seeking motherhood, 13 became pregnant (72%). There were 12 live births in 10 women, with a median fetal weight of 2490 grams (range; 1640-3560) and five miscarriages. After a median follow-up of 94.5 months (range; 6-183) three recurrences (11.1%) were detected, one patient (3.7%) died of the disease.Neoadjuvant chemotherapy followed by radical vaginal trachelectomy may be offered to patients seeking motherhood with cervical cancer >2 cm and histopathologically tumor-free lymph nodes, the rate of healthy baby pregnancy on discharge was 10/18 women (55%). This fertility-preserving strategy is associated with higher recurrence and death compared with what was published in the literature for women undergoing radical vaginal trachelectomy for tumors up to 2 cm.© IGCS and ESGO 2023. No commercial re-use. See rights and permissions. Published by BMJ.