To identify a specific population who might benefit from cervical conization prior to radical hysterectomy (RH).
From six institutions in Korea, we identified patients with node-negative, margin-negative, parametria-negative, 2009 FIGO stage IB1 cervical cancer who received primary Type C RH between January 2006 and December 2021. Patients were divided into multiple groups by cervical tumor size, surgical approach, and histology. We conducted a series of independent 1:1 propensity score matching and compared survival outcomes between the conization and control groups.
In total, 1254 patients were included in this analysis: conization (n=355) and control (n=899). After matching, the conization group showed significantly better DFS (P=0.001) and OS (P=0.019) than the control group. Among the matched patients with squamous cell carcinoma (SCC) and cervical tumor >2 cm, the conization group showed significantly better DFS than the control group when MIS RH was conducted (3-year DFS rate, 96.3% vs. 87.4%; P=0.007 and aHR, 0.271; 95% CI, 0.100–0.736; P=0.010), but not open RH. Among the matched patients with non-SCC and cervical tumor >2 cm, the conization group showed significantly better DFS than the control group when MIS RH was conducted (3-year DFS rate, 97.0% vs. 74.8%; P=0.021 and aHR, 0.198; 95% CI, 0.043–0.916; P=0.038), but not open RH. However, no difference in DFS was observed between the conization and control groups among the matched patients with cervical tumor ≤2 cm, regardless of the surgical approach. In patients who underwent open RH, DFS did not differ by uterine residual tumor size. In contrast, DFS was significantly worsened as the size of the uterine residual tumor increased from >0 and ≤1 cm to >3 and ≤4 cm in patients who underwent MIS RH (P
Patients with 2009 FIGO stage IB1 cervical cancer having a cervical tumor >2 cm who are scheduled to undergo primary MIS RH might benefit from cervical conization, as conization was associated with a lower recurrence rate. Although there was no survival benefit from cervical conization in patients with cervical tumor ≤2cm, cervical conization purporting to minimize the uterine residual tumor may be worth considering before MIS RH.