Background: Many physicians advocate repeat surgery after cervical conization with a diagnosis of cervical cancer stage FIGO IA1. In a multicenter trial, whether repeat surgery is a necessary therapeutic procedure in the treatment of cervical cancer stage FIGO IA1 was evaluated and a literature review performed.
Patients and methods: From 1997 to 2006, 156 patients with squamous cell cervical cancer, stage FIGO IA1, were primarily treated with conization in three different institutions; 102 of these patients underwent repeat surgery, comprising the study group for the present trial.
Results: In the conization specimen, 22 patients had clear resection margins, none of whom had residual dysplasia in the repeat conization/hysterectomy specimen. Sixty-four patients had cervical intraepithelial neoplasia (CIN) I-III at the conization resection margin; of these, 29, 9, 24, and 2 patients had no sign of residual dysplasia, CIN I, CIN II/III, or multifocal cervical cancer FIGO IA1 in the repeat conization/hysterectomy specimen, respectively. Sixteen patients had invasive cancer at the resection margin of the conization specimen; no sign of dysplasia, CIN I, CIN II/III, or residual cervical cancer were found in the repeat conization/hysterectomy specimen in 4, 1, 5, and 6 cases, respectively. In a multivariate analysis, risk factors for residual CIN II/III or multifocal invasive carcinoma in patients with CIN at the resection margin were advanced patient age and presence of multifocal invasive cervical cancer, but not depth of invasion, lymphovascular space involvement (LVSI), nor positive endocervical curettage.
Conclusion: The risk of residual dysplasia after conization of FIGO IA1 cervical cancer with clear margins is minimal. A considerable number of patients with locally resected FIGO IA1 cervical cancer, who had CIN I-III at the resection margin, showed signs of residual high-grade CIN or multifocal cervical cancer. The need for repeat surgery when signs of invasive carcinoma are present at the resection margins after conization is clear.