Objective: This study was performed to evaluate the efficacy and feasibility of electrosurgical conization and cold coagulation as definitive treatments for patients with International Federation of Gynecology and Obstetrics stage IA₁ squamous cell carcinoma of the cervix and a resection margin free from (micro)invasive carcinoma after conization.

Methods: Patients with stage IA₁ cervical squamous cell carcinoma without lymphovascular space invasion who had been treated by electrosurgical conization and cold coagulation and who wanted to preserve fertility (or only undertake conservative treatment) were followed up without further surgical intervention. Patients with invasive or microinvasive carcinoma at resection margins or positive endocervical resection margins were excluded from the study. Cervicovaginal smears and colposcopic examination were performed at regular intervals. Disease recurrence was defined as a histologic diagnosis of cervical intraepithelial neoplasia 2 or higher-grade lesions.

Results: A total of 85 patients enrolled were deemed eligible to be involved in the study. The median follow-up period was 81.0 months (range, 13-127 months). Nineteen of the 85 patients had exocervical resection margins. There was one case of recurrence, which was node-positive invasive cancer recurrence (1.2%, 1/85), in patients with negative resection margins.

Conclusions: These results suggest that electrosurgical conization with cold coagulation is a feasible treatment and could be used as a definitive therapy for patients with stage IA₁ cervical squamous cell carcinoma without lymphovascular space invasion. In addition, patients having cervical intraepithelial neoplasias 2 and 3 at exocervical resection margins could be followed up carefully without further treatment after conization and cold coagulation.