Trachelectomy in decline: national trends, outcomes, and academic output across 3 major databases

BACKGROUND: In 2021, the ConCerv study provided the first prospective evidence that fertility-sparing surgery, including conization or simple hysterectomy, was safe in low-risk cervical cancer, and recurrence rates remained low, although oncologic outcomes were not the primary endpoint. OBJECTIVE: This study aimed to examine temporal trends in 2 fertility-sparing procedures for cervical cancer (trachelectomy and conization) along with associated oncologic outcomes and patterns of academic productivity via 3 separate datasets. STUDY DESIGN: This was a retrospective study of 3 separate database, integrating clinical data from the National Cancer Database (2004-2022; for oncologic outcomes and surgical trends), perioperative outcomes from the American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files (2012-2022; for postoperative complications), and scholarly output from the Web of Science Core Collection (2000-2025; for bibliometric analysis). In the National Cancer Database, we identified two cohorts of patients aged 18 to 45 years with cervical cancer, irrespective of histologic subtype, who were managed with conservative surgery and nodal staging: the first cohort underwent trachelectomy (radicality not specified), whereas the second cohort underwent conization. Temporal trends were examined using annual procedure counts, proportional utilization, and annual percentage change. Clinicopathologic characteristics were descriptively summarized and compared using appropriate parametric or nonparametric tests and chi-squared tests, with Bonferroni correction for multiple comparisons. Overall survival was analyzed in node-negative cases using Kaplan-Meier and log-rank methods, and treatment effects were evaluated with multivariate Cox regression adjusted for stage, histology, surgical margins, and tumor size, reporting hazard ratios with 95% confidence intervals. RESULTS: A total of 1841 patients underwent conservative surgery with lymph node assessment, including 911 trachelectomies (49.5%) and 930 conizations (50.5%). Patients who underwent trachelectomy were younger than those who underwent conization (median: 31 vs 33 years, respectively; P