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Oncologic and obstetric outcomes after simple conization for fertility-sparing surgery in FIGO 2018 stage IB1 cervical cancer
  1. Francesco Fanfani1,2,
  2. Luigi Pedone Anchora1,
  3. Giampaolo Di Martino3,
  4. Nicolò Bizzarri1,
  5. Maria Letizia Di Meo4,
  6. Vittoria Carbone1,
  7. Mariachiara Paderno4,
  8. Camilla Fedele1,2,
  9. Cristiana Paniga4,
  10. Anna Fagotti1,2,
  11. Fabio Landoni3,
  12. Giovanni Scambia1,2 and
  13. Alessandro Buda3
  1. 1 Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A Gemelli, IRCCS, Rome, Italy
  2. 2 Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Rome, Italy
  3. 3 Department of Obstetrics and Gynecology, Gynaecologic Oncology Surgical Unit, ASST-Monza, San Gerardo Hospital, Monza, Italy
  4. 4 University of Milano-Bicocca, Monza, Italy
  1. Correspondence to Dr Francesco Fanfani, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma 00168, Italy; francesco.fanfani74{at}gmail.com; Dr Luigi Pedone Anchora; luigi.us{at}hotmail.it

Abstract

Objective Conization/simple trachelectomy is feasible in patients with early-stage cervical cancer. Retrospective data suggest that conization with negative lymph nodes could be a safe option for these patients. This study aims to provide oncologic and obstetric outcomes of a large series of patients with 2018 International Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical cancer managed by conization.

Methods Patients with early cervical cancer and a desire to preserve fertility who underwent conization and pelvic lymphadenectomy from January 1993 to December 2019 in two Italian centers were included. Inclusion criteria were: age >18 years and ≤45 years, 2018 FIGO stage IB1, no prior irradiation or chemotherapy, absence of pre-operative radiologic evidence of nodal metastases, a strong desire to preserve fertility, and absence of concomitant malignancies. We excluded patients with confirmed infertility, neuroendocrine tumor, clear cell or mucinous carcinoma.

Results A total of 42 patients were included. The median age was 32 years (range 19–44) and median tumor size was 11 mm (range 8–20). Squamous cell carcinoma was found in 27 (64.3%). Grade 3 tumor was present in 7 (16.7%) patients and lymphovascular space involvement was detected in 15 (35.7%). At a median follow-up of 54 months (range 1–185), all patients were alive without evidence of disease. In the entire series three patients experienced recurrence resulting in an overall recurrence rate of 7.1%. All the recurrences occurred in the pelvis (2 in the cervix and 1 in the lymph nodes), resulting in a 3-year disease-free survival of 91.6%. Twenty-two (52%) patients tried to conceive; 18 pregnancies occurred in 17 patients and 12 live births were reported (6 pre-term and 6 term pregnancies). Two miscarriages were recorded, one first trimester and one second trimester fetal loss.

Conclusions Our study showed that conization is feasible for the conservative management of women with stage IB1 cervical cancer desiring fertility. Oncologic outcomes appear favorable in this series of patients. Future prospective studies will hopefully provide further insight into this important question.

  • cervical cancer

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Footnotes

  • FF and LPA are joint first authors.

  • Twitter @frafanfani, @luigianchora, @annafagottimd

  • FF and LPA contributed equally.

  • Contributors All the authors participated in the trial design and manuscript preparation/revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Data availability statement Data are available upon reasonable request to star.center@policlinicogemelli.it.

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