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

Abstract

Objective To evaluate association of preoperative conization with recurrences after laparoscopic radical hysterectomy (LRH) for FIGO 2018 stage IB1 cervical cancer. Methods This is a retrospective single-center study. Patients who underwent LRH for cervical cancer with squamous, adenosquamous and adenocarcinoma subtype from January 2014 to December 2018 were reviewed. All patients were restaged according to the 2018 FIGO staging system. Those who were in FIGO 2018 stage IB1 met the inclusion criteria. General characteristics and oncologic outcomes including recurrence-free survival (RFS) were analyzed. Results A total of 1273 patients were included in the analysis. 616 (48.4%) patients underwent preoperative biopsy, and 657 (51.6%) patients underwent conization. Residual disease was observed in 822 (64.6%) patients. During a median follow-up of 50.30 months, 30 (2.4%) patients experienced recurrence. The univariate analysis showed that patients who had larger tumor diameter, the presence of residual tumor at final pathology, and underwent adjuvant treatment had a significant higher risk of recurrence (P < 0.01). Conversely, patients who underwent conization were significantly less likely to experience recurrence (P = 0.001). In the multivariate analysis, the independent risk factor associated with an increased risk of recurrence was resident macroscopic tumor (HR: 38.4, 95% CI 4.20–351.64, P = 0.001). On the contrary, preoperative conization was associated with a significantly lower risk of recurrence (HR: 0.26; 95% CI 0.10–0.63, P = 0.003). The Kaplan–Meier curves showed patients who underwent conization had improved survival over those who underwent biopsy (5 year RFS: 98.6 vs 95.1%, P = 0.001). The 5 year RFS of patients with residual tumor was significantly different (R0: 99.2%, R1: 97.4%, R2: 93.6%, P < 0.001), especially the patients with residual macroscopic tumor after conization (R0: 99.5%, R1: 99.0%, R2:92.4%, P = 0.006). Conclusion Preoperative conization and the absence of residual tumor at the time of surgery might play a protective role in patients with FIGO 2018 IB1 cervical cancer following LRH, which support the theory of the influence of intraoperative tumor spread during radical hysterectomy. Further prospective evidence is needed.

Outcomes of Radical Hysterectomy for Early-Stage Cervical Carcinoma, with or without Prior Cervical Excision Procedure

“…Following propensity score matching, the authors found a protective effect of conization in recurrence rates limited to patients with tumors larger than 2 cm who underwent minimally invasive surgery [ 14 ]. In a single-institution study from China, among 1273 patients with FIGO 2018 stage IB1 disease (tumor size ≤ 2 cm), the rate of prior conization was 51.6% [ 15 ]. Residual disease in the hysterectomy specimen was present in 64.6% of patients.…”

“…Residual disease in the hysterectomy specimen was present in 64.6% of patients. After a median follow-up of 50.3 months, 2.4% of patients recurred [ 15 ]. By multivariable analysis, the performance of conization was associated with lower probability of tumor relapse (HR: 0.26, 95% CI: 0.10, 0.63) as well as improved 5-year recurrence-free (98.6% vs. 95.1%, p = 0.001) and overall (99.2% vs. 97.2%, p = 0.035) survival [ 15 ].…”

“…After a median follow-up of 50.3 months, 2.4% of patients recurred [ 15 ]. By multivariable analysis, the performance of conization was associated with lower probability of tumor relapse (HR: 0.26, 95% CI: 0.10, 0.63) as well as improved 5-year recurrence-free (98.6% vs. 95.1%, p = 0.001) and overall (99.2% vs. 97.2%, p = 0.035) survival [ 15 ]. A recent systematic review of the literature and meta-analysis identified 11 studies reporting on 4184 patients who underwent radical hysterectomy; 2122 patients underwent a prior cervical excisional procedure (n = 2122) [ 19 ].…”

“…To date, it is unclear whether worse oncologic outcomes are attributed to the utilization of uterine manipulator that can introduce tumor cells into the abdominal cavity, the intraperitoneal spread of tumor cells during the performance of colpotomy in the steep Trendelenburg position, or inadequate surgical technique [ 7 ]. There are emerging data from several retrospective studies that suggest that the performance of preoperative cold knife cone may have a protective effect through a reduction in tumor size, especially if negative margins are obtained [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. However, given the small number of patients included in these studies, the heterogeneity of the population, and the inherent biases, conclusions cannot be drawn.…”