Conization With Lymph Node Assessment in Early-Stage Cervical Cancer: A Systematic Review and Meta-Analysis

Radical hysterectomy with pelvic lymphadenectomy has been considered the primary treatment for early-stage cervical cancer without lymph node involvement. This study aimed to evaluate recurrence rates and the prevalence of lymph node metastasis after treatment with conization combined with lymph node assessment.

A systematic literature search was conducted in PubMed, EMBASE, LILACS, Cochrane Library, SCOPUS, and Web of Science. After data extraction, a meta-analysis was performed. Heterogeneity was assessed, and publication bias was investigated using funnel plots and Egger's test, along with sensitivity analyses and exclusion of studies with sample size < 30.

Twelve studies including 548 women were included. The pooled recurrence rate after conservative surgery was 4% (95% CI: 2%-7%), with low heterogeneity (I² = 3.1%). Egger's test did not indicate relevant asymmetry (p = 0.0578). After excluding smaller studies (N < 30), the pooled estimate increased slightly to 5% (95% CI: 3.5%-7%), reflecting greater statistical stability. Regarding nodal positivity, the pooled rate was 3%, with no evidence of heterogeneity (I² = 0%). However, the funnel plot showed right-sided asymmetry, and Egger's test confirmed significant bias (p = 0.0016), suggesting influence from small studies with extreme effects. Excluding these studies increased the pooled estimate to 6% and narrowed the confidence interval, indicating greater precision.

Conservative surgery with lymph node evaluation showed low tumor recurrence and low lymph node positivity rates, supporting its feasibility as an alternative approach that may preserve oncologic effectiveness while reducing morbidity.