title: Simple conization and lymphadenectomy for the conservative treatment of stage IB1 cervical cancer. An Italian experience.
abstract: OBJECTIVE
  Simple conization represents a plausible treatment scheme for managing stage IA1-2 tumors conservatively. However its curative potential has not been widely exploited as regards stage IB1 lesions. Recent studies suggest that, in selected circumstances, patients with stage IB1 disease undergoing radical hysterectomy could have been safely cured by simple hysterectomy and even by cervical conization.
  
  
  METHODS
  Patients with stage IB1 cervical cancer desiring conservative management underwent simple conization and pelvic lymphadenectomy in three Italian institutes.
  
  
  RESULTS
  Thirty-six women received the conservative treatment since 1995 to 2010. Median age was 31 (range 24-40) years and median tumor size was 11.7 mm (range 8-25 mm). Adenocarcinoma was present in 12 cases (33%) and grade 3 neoplasia in 5 (14%). Lymph-vascular space involvement was detected in five patients (14%). Eleven had already a child while two had experienced an early abortion and a fetal loss at second trimester. After a median follow-up of 66 months (range 6-168) only one pelvic lymphnodal relapse was observed. Twenty-one pregnancies occurred in 17 patients and 14 live babies have been born (two preterm at 27 and 32 weeks) while one is ongoing. Three first-trimester miscarriages, one second-trimester fetal loss, an ectopic pregnancy and a termination of pregnancy have been recorded. Five patients decided to undergo hysterectomy after 3-12 years after conservative therapy: in one residual microinvasive adenocarcinoma was found.
  
  
  CONCLUSIONS
  Cervical conization represents a feasible conservative management of stage IB1 cervical cancer and shows a low risk of relapse, provided that patients are selected carefully. Conization would be suitable to treat stage IB lesions smaller than 15-20mm. with pathologic negative lymphnodes.
authors: Gynaecologic Oncology Unit, Azienda Ospedaliera Bolognini, Seriate, Italy. andrea.maneo@bolognini.bg.it
authors: Andrea
authors: A
authors: Maneo
authors: Mario
authors: M
authors: Sideri
authors: Giovanni
authors: G
authors: Scambia
authors: Sara
authors: S
authors: Boveri
authors: Tiziana
authors: T
authors: Dell'anna
authors: Mario
authors: M
authors: Villa
authors: Gabriella
authors: G
authors: Parma
authors: Anna
authors: A
authors: Fagotti
authors: Francesco
authors: F
authors: Fanfani
authors: Fabio
authors: F
authors: Landoni
mesh_terms: D000328:Adult; D019092:Conization / Q000379:methods*; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D009367:Neoplasm Staging; D011247:Pregnancy; D011256:Pregnancy Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult