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23 Concerv: a prospective trial of conservative surgery for low-risk early stage cervical cancer
  1. K Schmeler1,
  2. R Pareja2,
  3. A Lopez3,
  4. JH Fregnani4,
  5. A Lopes5,
  6. M Perrotta6,
  7. A Tsunoda7,
  8. D Cantu8,
  9. JM Carvajal8,
  10. L Ramondetta1,
  11. T Manchana9,
  12. D Crotzer10,
  13. O McNally11,
  14. M Riege12,
  15. LC Turco13,
  16. J Di Guilmi14,
  17. G Rendon15,
  18. P Ramalingam16,
  19. B Fellman17,
  20. M Frumovitz1,
  21. R Coleman1 and
  22. P Ramirez1
  1. 1MD Anderson Cancer Center, Gynecologic Oncology, Houston, USA
  2. 2Clinica de Oncologia Astorga, Gynecologic Oncology, Medellin, Colombia
  3. 3INEN, Gynecologic Oncology, Lima, Peru
  4. 4AC Camargo, Gynecologic Oncology, Sao Paulo, Brazil
  5. 5Instituto Brasileiro de Controle do Cancer, Gynecologic Oncology, Sao Paulo, Brazil
  6. 6Hospital Italiano, Gynecologic Oncology, Buenos Aires, Argentina
  7. 7Hospital Erasto Gaertner, Gynecologic Oncology, Curitiba, Brazil
  8. 8INCAN, Gynecologic Oncology, Mexico City, Mexico
  9. 9Chulalongkorn University, Gynecologic Oncology, Bangkok, Thailand
  10. 10Nebraska Methodist Hospital, Gynecologic Oncology, Omaha, USA
  11. 11Royal Womens Hospital, Gynecologic Oncology, Melbourne, Australia
  12. 12Instituto de Ginecologia, Gynecologic Oncology, Rosario, Argentina
  13. 13Policlinico Gemelli, Gynecologic Oncology, Rome, Italy
  14. 14Hospital Britanico, Gynecologic Oncology, Buenos Aires, Argentina
  15. 15IDC, Gynecologic Oncology, Medellin, Colombia
  16. 16MD Anderson Cancer Center, Pathology, Houston, USA
  17. 17MD Anderson Cancer Center, Biostatistics, Houston, USA


Objectives To prospectively evaluate the oncologic outcomes of conservative surgery in women with early stage cervical cancer.

Methods From 2009–2019, a prospective, multicenter study evaluated conservative surgery in 100 eligible women from 16 sites in 9 countries. Eligibility criteria included: 1) FIGO 2009 stage IA2-IB1 cervical carcinoma; 2) squamous or adenocarcinoma histology; 3) tumor size <2 cm; 4) no lymphovascular space invasion; 4) depth of invasion <10 mm; and 5) cone biopsy with negative margins (one repeat cone biopsy allowed). Women desiring future fertility underwent cervical conization and pelvic lymph node (LN) assessment consisting of sentinel LN biopsy and/or full pelvic LN dissection. Those not desiring future fertility underwent simple hysterectomy with LN assessment. All pathologic specimens were centrally reviewed by an expert gynecologic pathologist.

Results Median age at surgery was 38 years (range; 23–67). Stage at diagnosis was IA2 (33%) and IB1 (67%). Histologic type included squamous cell carcinoma (48%) and adenocarcinoma (52%). Surgery included conization and LN assessment in 44/100 (44%) women and simple hysterectomy with LN assessment in 56/100 (56%) women. Minimally invasive surgery (MIS) was performed in 96/100 (96%) patients: laparoscopic in 83; robotic in 13. Positive LNs were noted in 5/100 women (5%). Residual disease in the hysterectomy specimen was diagnosed in 1/56 patients (1.8%). Median follow-up was 25 months (range 0–71). To date, recurrent disease has been diagnosed in 3 patients (3%).

Conclusions Conservative surgery is oncologically safe in women with early stage, low-risk cervical carcinoma.

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