Louise Benoit1, Meriem Koual2,3,4, Huyen-Thu Nguyen-Xuan2,3, Vincent Balaya2,3, Claude Nos2, Rosa Montero-Macías2, Anne-Sophie Bats2,3,5. 1. Gynecologic and Breast Oncologic Surgery Department, APHP. Centre, European Georges-Pompidou Hospital, 20, rue Leblanc, 75908 Cedex 15, Paris, France. louise.am.benoit@gmail.com. 2. Gynecologic and Breast Oncologic Surgery Department, APHP. Centre, European Georges-Pompidou Hospital, 20, rue Leblanc, 75908 Cedex 15, Paris, France. 3. Faculty of Medicine, Paris University, Paris, France. 4. INSERM UMR-S 1124, Université de Paris, Centre Universitaire des Saint-Père, Paris, France. 5. INSERM UMR-S 1147, Université de Paris, Centre Universitaire des Saint-Père, Paris, France.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: Conization, through a reduction of tumor size, could improve DFS. Carefully selected patients could still benefit from minimally invasive surgery.
PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: Conization, through a reduction of tumor size, could improve DFS. Carefully selected patients could still benefit from minimally invasive surgery.
Entities:
Keywords:
Cervical cancer; Conization; Disease-free survival; Minimally invasive surgery
Authors: Jason D Wright; Thomas J Herzog; Alfred I Neugut; William M Burke; Yu-Shiang Lu; Sharyn N Lewin; Dawn L Hershman Journal: Gynecol Oncol Date: 2012-06-24 Impact factor: 5.482
Authors: F Mignot; S Gouy; A Schernberg; S Bockel; S Espenel; A Maulard; A Leary; C Genestie; P Annede; M Kissel; I Fumagalli; P Pautier; E Deutsch; C Haie-Meder; P Morice; C Chargari Journal: Gynecol Oncol Date: 2020-03-13 Impact factor: 5.482
Authors: Pedro T Ramirez; Michael Frumovitz; Rene Pareja; Aldo Lopez; Marcelo Vieira; Reitan Ribeiro; Alessandro Buda; Xiaojian Yan; Yao Shuzhong; Naven Chetty; David Isla; Mariano Tamura; Tao Zhu; Kristy P Robledo; Val Gebski; Rebecca Asher; Vanessa Behan; James L Nicklin; Robert L Coleman; Andreas Obermair Journal: N Engl J Med Date: 2018-10-31 Impact factor: 91.245
Authors: Freddie Bray; Jacques Ferlay; Isabelle Soerjomataram; Rebecca L Siegel; Lindsey A Torre; Ahmedin Jemal Journal: CA Cancer J Clin Date: 2018-09-12 Impact factor: 508.702
Authors: Kathleen A Cronin; Andrew J Lake; Susan Scott; Recinda L Sherman; Anne-Michelle Noone; Nadia Howlader; S Jane Henley; Robert N Anderson; Albert U Firth; Jiemin Ma; Betsy A Kohler; Ahmedin Jemal Journal: Cancer Date: 2018-05-22 Impact factor: 6.860