Tomao Federica, Maruccio Matteo, Preti Eleonora Petra, Boveri Sara, Ricciardi Enzo, Zanagnolo Vanna, Landoni Fabio
*European Institute of Oncology "IEO", Milan; and †University of Rome "Sapienza," Rome, Italy.
Int J Gynecol Cancer. 2017 Jun;27(5):1001-1008. doi: 10.1097/IGC.0000000000000991.
The main objective of this study was to analyze the pattern of recurrence after conization and pelvic lymphadenectomy in early-stage cervical cancer (CC).
We retrospectively identified 60 patients with early-stage CC who referred to the European Institute of Oncology (IEO; Milan, Italy) for fertility-sparing surgery. All of them underwent conization and pelvic lymphadenectomy (one received neoadjuvant chemotherapy followed by simple trachelectomy because of the size of the tumor).
In total, 54 patients were considered for final analysis; only 23 patients were entirely treated at IEO. Relapse occurred in 7 (13%) of 54 patients, and in 6 cases (86%) it was local. One patient experienced a pelvic lymph node recurrence (in a woman who conceived 4 months after conservative surgery). However, this was an atypical case for site and timing of recurrence with the consistent doubt that the nodal involvement was already present before conization. Thus, analyzing only IEO population, the recurrence rate was lower (9%), becoming 4% excluding the atypical case with nodal involvement.
In our series, the relapse was mainly local (on the cervix). However, the pattern of recurrence and recurrence rates after conization and pelvic lymphadenectomy for early-stage CC are still unclear. Further studies, comparing conization with radical trachelectomy, are necessary to confirm that the adoption of this procedure in clinical practice is safe. Our data highlight that the management of such as a particular condition in dedicated and highly specialized centers is mandatory.
本研究的主要目的是分析早期宫颈癌（CC）锥切术和盆腔淋巴结清扫术后的复发模式。
我们回顾性地确定了60例因保留生育功能手术转诊至欧洲肿瘤研究所（IEO；意大利米兰）的早期CC患者。所有患者均接受了锥切术和盆腔淋巴结清扫术（1例因肿瘤大小接受了新辅助化疗，随后进行了单纯宫颈切除术）。
总共54例患者纳入最终分析；仅23例患者在IEO接受了完整治疗。54例患者中有7例（13%）复发，其中6例（86%）为局部复发。1例患者出现盆腔淋巴结复发（1名女性在保守手术后4个月怀孕）。然而，这是1例复发部位和时间均不典型的病例，一直存在淋巴结受累在锥切术前就已存在的疑问。因此，仅分析IEO的患者群体，复发率较低（9%），排除淋巴结受累的非典型病例后为4%。
在我们的系列研究中，复发主要为局部复发（在宫颈）。然而，早期CC锥切术和盆腔淋巴结清扫术后的复发模式和复发率仍不明确。有必要进行进一步研究，比较锥切术与根治性宫颈切除术，以证实该手术在临床实践中的应用是安全的。我们的数据强调，在专门的高度专业化中心处理这种特殊情况是必要的。
