Wertheim proposed the extensive total hysterectomy (ETH) in 1895, and in 1930, Meigs further refined this approach by proposing pelvic lymphadenectomy. At that time, due to the absence of screening approach and effective adjuvant therapies such as radiotherapy, surgeons favored expanding the surgical extent; however, this approach was associated with a high incidence of complications. In the early 21st century, several retrospective studies demonstrated that parametrial metastasis rates were relatively low in low-risk early-stage cervical cancer, providing a theoretical foundation for fertility-sparing surgery (FSS) approaches. The ConCerv study, initiated in 2010, and the SHAPE study, launched in 2012, further investigated the feasibility and safety of FSS for low-risk early-stage cervical cancer. While the ConCerv study suggested that FSS might be safe and feasible, this study lacked a control group. Moreover, the SHAPE study, through a large-scale randomized controlled trial, confirmed that extrafascial total hysterectomy did not increase the pelvic recurrence rate in low-risk early-stage cervical cancer and offered advantages over radical surgery in terms of complications and quality of life. Nevertheless, directly translating these findings into clinical practice remains premature. Accurately identifying low-risk cervical cancer patients preoperatively poses challenges, such as inaccuracies in assessing tumor size and depth of stromal invasion. Additionally, whether lymphovascular space invasion (LVSI) constitutes a high-risk factor remains unclear. It is recommended to perform cervical conization for pathological evaluation prior to FSS and utilize MRI for auxiliary assessment. Although both studies validated the feasibility and safety of FSS for low-risk early-stage cervical cancer, caution is warranted when considering changing traditional clinical practices. For fertility-sparing patients, FSS may offer benefits; however, for non-fertility-sparing patients, given the relatively late average age of onset of cervical cancer in China, the practical significance of FSS may be limited. Further clinical research is anticipated to address the limitations of existing studies and elucidate the role of FSS more clearly.