621 Ultra-conservative fertility sparing treatment in early cervical cancer: oncological and obstetric outcomes in a tertiary cancer center

Introduction/Background To analyze the oncological and obstetric outcomes in women affected by early-stage cervical cancer (CC) who underwent ultra-conservative fertility sparing treatment in a single cancer institution during 20 years time frame Methodology All women diagnosed with cervical cancer at stages FIGO IA1-IB2 (≤ 3cm),referred to the European Institute of Oncology (IEO) in Milan, Italy, for fertility-sparing surgery, were identified between August 2003 and January 2023. Patients with stage IA1-IB1 (≤ 2 cm) underwent cervical surgery (LEEP/conization or simple trachelectomy), sentinel lymph node biopsy (BLS), or pelvic lymphadenectomy (PL). Whenever high prognostic risk factors were identified, patients received adjuvant chemotherapy. Patients with stage IB2 (2 to3 cm) received PL, neoadjuvant chemotherapy (NACT), and then cervical surgery. Results In total, 178 patients were considered for final analysis. 6.7% receiving NACT, of which 25% achieved complete response and 75% partial response. 11.2% received adjuvant chemotherapy. The mean follow-up was 140 months, with recurrence rate 7.8%. 5 years-OS was 99.2%, with 96% at 218 months. 5 years- DFS 90.1%, slightly lower at 218 months. Positive margins at the time of initial conization and the presence of lymphovascular space invasion (LVSI) are associated with high prognostic risk factors for recurrence, with p-values of 0.05 and 0.06, respectively. Positive surgical margins are associated with the surgical technique used (39.3% LEEP, 31.5% CKC, laser conization 22.7%). Sixty-seven pregnancies were observed with full-term, preterm deliveries and live birth rate of 70.1%, 8.9%, 79.1% respectively. Conclusion Ultra conservative fertility surgery represents a feasible treatment with optimal obstetric outcomes in selected women with early CC. In particular, surgical margin status at the time of the first conization with the presence of LVSI are the most important risk factors for recurrences. Ideally, women with early-stage cervical cancer should be referred as soon as possible to a specialized tertiary referral center Disclosures Disclores for E.Preti - N. Colombo COI added.