Objectives To ascertain whether preoperative cervical conization decreases disease recurrence and mortality rates in patients with early cervical cancer who undergo radical hysterectomy (RH).

Methods We retrospectively identified 2014 FIGO stage IB cervical cancer who received primary RH by either minimally invasive surgery (MIS) or open surgery between 2005 and 2020. To adjust for confounders, we conducted a 1:2 propensity score matching for stage, histology, cervical mass size, and surgical approach. Then, survival outcomes were compared between the matched conization and non-conization groups.

Results A total of 429 patients were included: 96 (22.4%) received preoperative conization. Overall, the conization group had significantly less cervical mass size (median, 24.0 vs. 30.0 mm; P=0.020) and lower incidence rates of parametrial invasion (4.2% vs. 15.0%; P=0.005), compared to the non-conization group. The conization group had a trend towards MIS RH (54.2% vs. 43.2%; P=0.058). After matching, the conization group showed significantly better progression-free survival (PFS) than the non-conization group (n=192) (3-year: 96.8% vs. 86.5%; P=0.011), but no difference in overall survival (OS). Excluding 15 patients who had parametrial invasion, lymph node metastasis, and both, we conducted another matching process and also found that the conization group had significantly better PFS (3-year: 86.1% vs. 98.8%; P=0.008), but the similar OS. Consistent results were also observed in the subgroup of MIS RH (n=150).

Conclusions Despite the retrospective design, our matched cohort study suggests that preoperative conization might be preferable for the surgical treatment of FIGO stage IB cervical cancer, especially for those who are planning to undergo MIS RH.