title: Management of stage Ia1 squamous cervical cancer and the importance of excision margins: a retrospective study of long-term outcome after 25 years of follow-up.
abstract: OBJECTIVE
  The aim of this study was to assess the effect of the excision margin after cone for stage Ia1 cervical cancer on long-term outcomes.
  
  
  METHODS
  Retrospective observational study. Patients were divided into 3 groups. Group A underwent immediate reflex hysterectomy; group B had cervical intraepithelial neoplasia (CIN) at the margins but were followed up; group C had clear margins.
  
  
  RESULTS
  We identified 111 women: 19 (17.1%) in group A; 29 (26.1%) in group B; and 63 (56.8%) in group C. Women in group A were older (median, 40 years vs 35 years; P = .0001) with higher rate of endocervical margin involvement (89.5 vs 48.1%, P = .007) than in group B. The women had been followed for a total of 960 woman-years with median follow-up of 398 weeks (quartiles: 258,612). Women with clear margins in the initial excision were more likely to remain free of disease than those with involved (P < .0001). Further surgery was required due to abnormal cytology in 9 (31.0%) women from group B and 7 (11.1%) from group C (P = .04). The cumulative rate of recurrent CIN2+ was 6.4% in group B and 2.7% in group C (P = .17). In group B, recurrences were more common in positive endocervical rather than ectocervical margins (66.6% vs 33.4%, P < .05); all had high-grade CIN at the margins.
  
  
  CONCLUSIONS
  The risk of posttreatment CIN2+ is substantially reduced when complete excision is achieved at first treatment. Conservative management is contraindicated in women with microinvasion at the margin. When CIN involves the margin, there is a greater risk of residual disease and of further treatment.
authors.affiliation: West London Gynaecological Cancer Centre, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust, London, England, UK.
authors.forename: Katerina
authors.initials: K
authors.lastname: Papakonstantinou
authors.affiliation: West London Gynaecological Cancer Centre, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust, London, England, UK; Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, England, UK. Electronic address: m.kyrgiou@imperial.ac.uk.
authors.forename: Maria
authors.initials: M
authors.lastname: Kyrgiou
authors.affiliation: Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial Healthcare NHS Trust, London, England, UK.
authors.forename: Deidre
authors.initials: D
authors.lastname: Lyons
authors.affiliation: Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, England, UK.
authors.forename: William P
authors.initials: WP
authors.lastname: Soutter
authors.affiliation: West London Gynaecological Cancer Centre, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust, London, England, UK; Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, England, UK.
authors.forename: Sadaf
authors.initials: S
authors.lastname: Ghaem-Maghami
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002584:Cervix Uteri / Q000473:pathology / Q000601:surgery*; D019092:Conization; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D057832:Watchful Waiting; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology*
keywords: CIN; cervical cancer; conization; margins; microinvasion; recurrence