Is conization once following by simple hysterectomy sufficient for all clinical stage IA1 cervical squamous cell carcinoma?
OBJECTIVE
The goal of this study is to assess the feasibility of simple extrafascial hysterectomy for patients with clinical stage IA1 cervical squamous cell carcinoma (SCC) after once conization regardless of any pathologic risk factor.


METHODS
All cases with T1a1, SCC lesion in their cervical cone specimen were retrospectively collected after chart and pathology review for the period between January 2002 and December 2009. All cases underwent subsequent hysterectomies within a month of diagnosis. Pathologic risk factors of conization, surgical scale of hysterectomy, residual lesion of the uterus, necessity of adjuvant radiation therapy, complications, and survival were analyzed in this study.


RESULTS
Eighty-one cases were identified from the registry. Most were managed by simple hysterectomy (SH; 60/81, 74%), and the remaining 21 cases underwent modified radical hysterectomy (MRH). All cases without any risk factors in their cone specimens demonstrated residual lesion ≤T1a1 in both SH and MRH groups, whereas those with existing risk factor were confirmed positive for residual lesions ≤T1a1 [SH, 95.8% (46/48) vs. MRH, 75% (15/20)]. Only two cases in the SH group received adjuvant radiation for residual lesions >T1a1. On the contrary, 15 cases in the MRH group can receive smaller scale surgery than MRH. All cases were recurrence-free without any permanent treatment-related complication by the end of the study.


CONCLUSIONS
Extrafascial simple hysterectomy may be recommended for clinical T1a1 cervical SCC regardless of the pathologic risk factor.
Department of Obstetrics and Gynecology, Mackay Memorial Hospital and Mackay Medical College, Taipei, Taiwan; Department of Nursing, Mackay Medicine, Nursing, and Management College, Taipei, Taiwan.
Jen-Ruei
JR
Chen
Mei-Ling
ML
Chiu
Tao-Yuean
TY
Wang
Tzu-Chien
TC
Chen
Kuo-Gon
KG
Wang
Tsung-Hsien
TH
Su
Chih-Long
CL
Chang
Yuh-Cheng
YC
Yang
Kung-Liahng
KL
Wang
D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery*; D002584:Cervix Uteri / Q000473:pathology / Q000601:surgery; D019092:Conization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*
cervical cancer; conization; hysterectomy; microinvasive; squamous cell carcinoma