Simple conization and lymphadenectomy for the conservative treatment of stage IB1 cervical cancer. An Italian experience

Andrea Maneo, Mario Sideri, Giovanni Scambia, Sara Boveri, Tiziana Dell'Anna, Mario Villa, Gabriella Parma, Anna Fagotti, Francesco Fanfani, Fabio Landoni

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Simple conization represents a plausible treatment scheme for managing stage IA1-2 tumors conservatively. However its curative potential has not been widely exploited as regards stage IB1 lesions. Recent studies suggest that, in selected circumstances, patients with stage IB1 disease undergoing radical hysterectomy could have been safely cured by simple hysterectomy and even by cervical conization. Methods: Patients with stage IB1 cervical cancer desiring conservative management underwent simple conization and pelvic lymphadenectomy in three Italian institutes. Results: Thirty-six women received the conservative treatment since 1995 to 2010. Median age was 31 (range 24-40) years and median tumor size was 11.7 mm (range 8-25 mm). Adenocarcinoma was present in 12 cases (33%) and grade 3 neoplasia in 5 (14%). Lymph-vascular space involvement was detected in five patients (14%). Eleven had already a child while two had experienced an early abortion and a fetal loss at second trimester. After a median follow-up of 66 months (range 6-168) only one pelvic lymphnodal relapse was observed. Twenty-one pregnancies occurred in 17 patients and 14 live babies have been born (two preterm at 27 and 32 weeks) while one is ongoing. Three first-trimester miscarriages, one second-trimester fetal loss, an ectopic pregnancy and a termination of pregnancy have been recorded. Five patients decided to undergo hysterectomy after 3-12 years after conservative therapy: in one residual microinvasive adenocarcinoma was found. Conclusions: Cervical conization represents a feasible conservative management of stage IB1 cervical cancer and shows a low risk of relapse, provided that patients are selected carefully. Conization would be suitable to treat stage IB lesions smaller than 15-20 mm. with pathologic negative lymphnodes.

Original languageEnglish
Pages (from-to)557-560
Number of pages4
JournalGynecologic Oncology
Volume123
Issue number3
DOIs
Publication statusPublished - Dec 2011

Keywords

  • Cervical cancer
  • Conization
  • Conservative surgery
  • Trachelectomy

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Oncology

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