Gynecologic and Breast Oncologic Surgery Department, APHP. Centre, European Georges-Pompidou Hospital, 20, rue Leblanc, 75908 Cedex 15, Paris, France.
Faculty of Medicine, Paris University, Paris, France.
Arch Gynecol Obstet. 2021 Jan;303(1):231-239. doi: 10.1007/s00404-020-05798-7. Epub 2020 Sep 22.
Ever since the recent findings showing the lack of benefit of minimally invasive surgery (MIS) versus open surgery in early-stage cervical cancer, gynecologists have tried to explain these results. The primary objective of our study was to assess the impact of pre-operative conization on disease-free survival (DFS) in early-stage cervical cancer. The secondary objective was to analyze the peri-operative morbidity associated with a pre-operative conization.
All patients undergoing a surgical management for early-stage squamous carcinoma or adenocarcinoma cervical cancer (IA1, IA2, IB1 and IB2 FIGO 2018) at a French university hospital from 2004 to 2018 were retrospectively included. We examined the association between conization and DFS using a Cox regression model. We also analyzed the morbidity associated with pre-operative conization.
48.4% (44/91) of the patients had a pre-operative conization (defined by a conization up to 90 days prior to surgery). 86.8% underwent MIS. There was a non-significant increase in the DFS with one patient presenting a recurrence in the conization group (2.3%) and six (12.8%) in the no conization group (log rank = 0.09). In univariate analysis, conization, definitive FIGO stage and pre-operative tumor size were associated with DFS (p < 0.2). Only pre-operative tumor size was significantly associated with DFS in multivariate analysis. There was a non-significant increase of adverse events in the conization group (43.2% in the conization group versus 23.4%, p = 0.06).
Conization, through a reduction of tumor size, could improve DFS. Carefully selected patients could still benefit from minimally invasive surgery.
自从最近的研究结果表明微创外科（MIS）与早期宫颈癌的开放性手术相比没有益处以来，妇科医生一直试图解释这些结果。我们研究的主要目的是评估术前锥切术对早期宫颈癌无病生存（DFS）的影响。次要目的是分析与术前锥切术相关的围手术期发病率。
回顾性纳入 2004 年至 2018 年期间在法国一家大学医院接受手术治疗的早期宫颈鳞癌或腺癌（FIGO 2018 分期 IA1、IA2、IB1 和 IB2）的所有患者。我们使用 Cox 回归模型检查锥切术与 DFS 之间的关系。我们还分析了术前锥切术相关的发病率。
48.4%（44/91）的患者有术前锥切术（定义为在手术前 90 天内进行锥切术）。86.8%行 MIS。在锥切组有 1 例患者出现复发（2.3%），而在未行锥切组有 6 例（12.8%）DFS 无显著增加（对数秩检验=0.09）。单因素分析显示，锥切术、明确的 FIGO 分期和术前肿瘤大小与 DFS 相关（p<0.2）。多因素分析显示，只有术前肿瘤大小与 DFS 显著相关。锥切组不良事件发生率略有增加（锥切组为 43.2%，而非锥切组为 23.4%，p=0.06）。
锥切术通过缩小肿瘤体积，可能改善 DFS。精心选择的患者仍可能从微创外科中受益。
