The aim of the study was to evaluate the oncologic and fertility results of women with cervix-confined cancer of more than 4 cm who received neoadjuvant chemotherapy followed by fertility-sparing surgery. The study was identified using the PROSPERO register (CRD42021254816). From inception through July 2021, PubMed/MEDLINE, ClinicalTrials, EMBASE, Cochrane Central Register of Controlled Trials, SCOPUS, and OVID were searched. Intra-cervical cancer patients with a tumor diameter of 4 cm or less (International Federation of Gynecology and Obstetrics (FIGO) 2018 stage I B3) who had undergone intra-venous neo-adjuvant chemotherapy with successful fertility-sparing surgery were included in this study. After the initial search, it was shown 2,990 items. A total of 40 patients from 11 studies had attempted fertility preservation surgery (conization, simple or radical trachelectomy) and in 26 patients (65%) it was succeeded. Platinum-based chemotherapy was used in all cases. Furthermore, 131 patients (55.9%) exhibited a complete pathological response, whereas two persons (7.7%) experienced a recurrence. The 4.5-year disease-free survival rate was 92.3%, and the 4.5-year overall survival rate was 100%. Of the six patients who attempted to conceive, four (67%) had at least one pregnancy and three of five (60%) pre-term deliveries after radical trachelectomy. Patients with recurrent disease received cisplatin and ifosfamide in place of cisplatin and paclitaxel, had non-radical surgery, and had evidence of residual disease in the last sample.There is insufficient evidence for fertility-sparing surgery in patients with cervical cancer and tumors greater than 4cm; nevertheless, it should be considered an experimental treatment.If neo-adjuvant chemotherapy is used, patients should have fertility-sparing radical surgery as the use of non-radical surgery may be a risk factor.
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