Association of preoperative cone biopsy with recurrences after radical hysterectomy

Abstract

Objective To evaluate association of preoperative cone biopsy with the probability of recurrent disease after radical hysterectomy for cervical cancer. Methods This is a retrospective single-center study. Patients with cervical cancer stage IA1 with LVSI to IIA2 and squamous, adenosquamous and adenocarcinoma subtype were included. Patients were analyzed for general characteristics and recurrence-free survival (RFS). Results In total, of 480 patients with cervical cancer, 183 patients met the inclusion criteria (117 with laparoscopic and 66 with open surgery). The median tumor diameter was 25.0 mm (range 4.6–70.0 mm) with 66 (36.2%) patients having tumors smaller than 2 cm. During median follow-up of 54.0 months (range 0–166.0 months), the RFS for the laparoscopic cohort was 93.2% and 87.5% at 3 and 4.5 years, and 79.3% for the open cohort after 3 and 4.5 years, respectively. In total, 17 (9.3%) patients developed recurrent disease, 9 (7.3%) after laparoscopic, and 8 (12.1%) after open surgery. No preoperative cone biopsy (OR 9.60, 95% CI 2.14–43.09) as well as tumor diameter > 2 cm (OR 5.39, 95% CI 1.20–24.25) were significantly associated with increased risk for recurrence. In multivariate analysis, only missing preoperative cone biopsy was significantly associated with increased risk for recurrence (OR 5.90, 95% CI 1.11–31.29) Conclusion There appears to be a subgroup of patients (preoperative cone biopsy, tumor diameter < 2 cm) with excellent survival and low risk for recurrence after radical hysterectomy which might benefit from the advantages of laparoscopic surgery.

Survival after minimally invasive radical hysterectomy without using uterine manipulator for early‐stage cervical cancer: A systematic review and meta‐analysis

“…The reasons were that a uterine manipulator was used, information on the use of uterine manipulator was lacking, patients who received neoadjuvant therapy or advanced stages of cervical cancer were involved. Finally, six studies were included in the meta‐analysis 19–24 …”

“…Detailed characteristics of the included studies are presented in Table 1. Studies were published between 2019 and 2022, with one study each conducted in Sweden, 19 Germany 22 and Norway, 23 two studies conducted in Japan 21,24 and one study jointly conducted in Europe 20 . None of the six studies had an randomised controlled trial (RCT) design.…”

“…The pooled results showed that the adjuvant therapy rate in the MIRH group was significantly lower than that of the ARH group (OR 0.46, 95% CI 0.25–0.85, Figure 3B), although there was high heterogeneity between studies ( P = 0.002, I 2 = 79%). Sensitivity analyses revealed unstable results when three studies 22–24 were excluded, respectively. The results remained statistically significant after altering the selection of the effect models.…”

“…Finally, six studies were included in the meta-analysis. [19][20][21][22][23][24] Detailed characteristics of the included studies are presented in Table 1. Studies were published between 2019 and 2022, with one study each conducted in Sweden, 19 Germany 22 and Norway, 23 two studies conducted in Japan 21,24 and one study jointly conducted in Europe.…”

Association of preoperative conization with recurrences after laparoscopic radical hysterectomy for FIGO 2018 stage IB1 cervical cancer

“…Contradictory results of various studies lead to the hypothesis that reduced survival after MIS might depend on failure to prevent tumor cell contamination through the use of uterine manipulators, intracorporal colpotomy or lack of vaginal cuff closure [10][11][12][13]. Recent studies showed that patients who underwent preoperative conization appear to have excellent survival even after laparoscopic surgery [14][15][16][17][18][19]. However, the enrolled population in these studies was based on the preoperative diagnosis with confounding factors such as larger tumor size, lymph node metastasis, and different surgical approach.…”