Department of Obstetrics and Gynecology, Medical University of Vienna, A-1090 Vienna, Waehringer Gürtel 18-20, Austria.
Anticancer Res. 2010 Feb;30(2):565-8.
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.
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.
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.
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.
许多医生主张在宫颈锥切术后诊断为 FIGO IA1 期宫颈癌时再次手术。在一项多中心试验中，评估了重复手术是否是治疗 FIGO IA1 期宫颈癌的必要治疗程序，并进行了文献复习。
1997 年至 2006 年，在三个不同的机构中，156 例鳞状细胞宫颈癌、FIGO IA1 期患者主要接受了锥切术治疗；其中 102 例患者接受了再次手术，构成了本试验的研究组。
在锥切标本中，22 例患者有明确的切缘，在再次锥切/子宫切除标本中均无残留发育不良。64 例患者在锥切切缘处有宫颈上皮内瘤变（CIN）I-III；其中 29、9、24 和 2 例在再次锥切/子宫切除标本中无残留发育不良、CIN I、CIN II/III 或多灶性宫颈癌 FIGO IA1，分别。16 例患者在锥切标本的切缘处有浸润性癌；在再次锥切/子宫切除标本中，4、1、5 和 6 例分别未见发育不良、CIN I、CIN II/III 或残留宫颈癌。多变量分析显示，在切缘有 CIN 的患者中，残留 CIN II/III 或多灶性浸润性宫颈癌的危险因素是患者年龄较大和存在多灶性浸润性宫颈癌，而不是浸润深度、血管淋巴管间隙浸润（LVSI）或宫颈内膜刮除阳性。
在宫颈锥切术后，有明确切缘的 FIGO IA1 期宫颈癌残留发育不良的风险极小。相当多的局部切除的 FIGO IA1 期宫颈癌患者，在切缘处有 CIN I-III，表现出残留高级别 CIN 或多灶性宫颈癌的迹象。当锥切术后切缘有浸润性癌的迹象时，再次手术的必要性是明确的。
