Preoperative conization in cervical cancer patients undergoing open abdominal radical hysterectomy: Results from a...

Conization is a common diagnostic tool in cervical cancer, but its prognostic impact prior to abdominal radical hysterectomy remains unclear. This study examines conization's influence on outcomes in early and advanced cervical cancer, the significance of cone specimen resection margins, and the impact of hysterectomy timing post-conization.

Data from the Leipzig Mesometrial Resection (MMR) trial were retrospectively analyzed for patients with primary cervical cancer staged IB1-IIB (2009-FIGO). Open abdominal radical hysterectomy was performed as total or extended mesometrial resection (TMMR/EMMR). Propensity score matching and survival comparisons were conducted using the Kaplan-Meier method and Cox proportional hazards regression modeling.

Among 542 patients, 202 had conization during diagnostic workup. After 1:1 propensity score matching (163 patients per group), preoperative conization was associated with better recurrence-free (95.6 % vs. 82.3 %, HR 3.2, 95 % CI 1.4-7.0, p < 0.01) and overall (99.2 % vs. 85.6 %, HR 6.3, 95 % CI 1.9-21.1, p < 0.001) survival. In a multivariable Cox regression model, conization independently improved recurrence-free survival (HR 0.3, 95 % CI 0.1-0.6, p < 0.01). The cumulative risk of distant recurrence was significantly higher without conization (sHR 14.9, 95 % CI 1.9-114.9, p = 0.01), with no difference in local recurrences. Completeness of tumor removal by conization (R-status) had no prognostic impact. Delayed radical hysterectomy ≥28 days post-conization was associated with improved overall survival (p = 0.02).

Preoperative conization was associated with improved survival in cervical cancer patients undergoing open abdominal radical hysterectomy, irrespective of resection margin, nodal status, or parametrial involvement. Delaying radical hysterectomy by ≥28 days post-conization further enhanced survival and reduced distant metastases.