Introduction/Background Lympho-vascular space invasion (LVSI) in cervical cancer (CC) is an adverse prognostic feature, often prompting radical treatment, even in early-stage disease. However, the imperative for aggressive intervention has recently been questioned considering the associated morbidities. This study aims to appraise the outcomes of non-radical surgery in stage IA1-IB1 CC with LVSI.

Methodology Patients with International Federation of Obstetrics and Gynecology (FIGO) 2018 stage IA1-IB1 CC who underwent non-radical surgery (type A hysterectomy or conization) between 1/1/2009–12/31/2019 were retrospectively identified. Repeat conization was permitted. All patients underwent bilateral sentinel lymph node (SLN) mapping or lymphadenectomy. Patients with positive nodes, incomplete nodal evaluation, or histology other than squamous or grade 1/2 adenocarcinoma were excluded.

Results Seventy-one patients met inclusion criteria, 26(37%) with LVSI and 45(63%) without. Median age was 36 years (range, 23–71). Thirty-one patients (44%) had stage IA1, 15(21%) stage IA2, and 25(35%) stage IB1 disease; 36 tumors (51%) were adenocarcinoma and 35(49%) squamous histology.

For primary treatment, 68 patients (96%) underwent conization and 3(4%) hysterectomy. Of the 68 patients, 4(6%) had SLN, 40(59%) required repeat conization with SLN, 20(29%) hysterectomy with SLN, and 4(6%) hysterectomy with SLN after repeat conization (figure 1).

Patients with LVSI were younger (33 vs 40 years, P<.001) and more likely to have squamous histology (69% vs 38%, P=.04) and stage IA1 disease (61% vs 33%, P=.06). Of 26 patients with LVSI, 3 (all with stage IA1 disease) underwent hysterectomy. Rates of positive endocervical curettage following first conization (36% vs 35%) and of residual disease on final specimen (27% vs 40%) were not different between groups.

Median follow-up was 62 months (range, 1–157). No recurrences or deaths occurred among patients with LVSI vs 2 recurrences among patients without.

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Abstract 184 Figure 1

Sankey chart showing surgical pathway from diagnoasis to final procedure (N=71)

Conclusion Less radical surgery may be safe for select patients with stage IA1-IB1 cervical cancer with positive LVSI and negative nodes.

Disclosures Kara Long-Roche reports travel support from Intuitive Surgical.

Mario M. Laitao Jr. is an ad hoc speaker for Intuitive Surgical, Inc., has consulted for Medtronic, and has served on the advisory boards of Ethicon/Johnson & Johnson and Immunogen.

Elizabeth Jewell Reports personal fees from Covidien/Medtronic

Dennis Chi reports personal fees from Apyx Medical, Verthermia Inc., Biom ‘Up, and AstraZeneca, as well as recent or current stock/options ownership of Apyx Medical, Verthemia, Intuitive Surgical, Inc., TransEnterix, Inc., Doximity, Moderna, and BioNTech SE.

Nadeem R. Abu-Rustum reports grant funding from GRAIL paid to the institution.