2022-RA-1597-ESGO Preoperative conization of early cervical carcinoma associated with improved progression free survival

Introduction/Background

Tumor cell contamination during laparoscopic radical hysterectomy appears to be associated with decreased survival. Preoperative cone biopsy might reduce the risk for tumor cell contamination. This study analyses the association of preoperative cone biopsy with survival after radical hysterectomy for cervical cancer.

Methodology

In total 276 patients with cervical carcinoma through FIGO IB1 were included in this singlecenter study. In this retrospective analysis, multivariate cox regression was performed by adjusting for age, lymph node status, tumor diameter, grading, preoperative conization, adjuvant therapy and surgical approach (abdominal, laparoscopic).

Results

For 52,5% of the patients the minimally invasive approach and for 44,9% the open abdominal approach was chosen, respectively. The surgical approach was neither a predictive marker for overall survival (OR 1,220; 95% KI: 0,460 – 3,236; p=0,689) nor for progression free survival (OR 1,295; 95% KI: 0,548 – 3,06; p=0,556) in our study. However, a preoperative conization was the only variable strongly associated with improved survival (OR 4,022; 95% KI: 1,243 – 13,012; p=0,020). In 114 patients with macroscopically complete tumor resection by conization 8 recurrences occurred. This could be a surrogate for the prognostic role of tumor cell contamination during laparoscopic hysterectomy in patients with macroscopic tumor.

Conclusion

Patients with preoperative conization represent a low risk collective that might still profit from laparoscopic hysterectomy. Further prospective, randomized studies on minimally invasive surgery for cervical cancer must include techniques to prevent intraoperative tumor cell contamination.