2022-RA-1002-ESGO Cervical Carcinoma Stage FIGO IA1 Without Lymphovascular Space Invasion: a 20 Years Conservative Treatment in the South of Brazil University Hospital

Introduction/Background FIGO proposes extrafascial hysterectomy or conization with negative margins as treatment options for stage IA1 cervical cancer (CC) without lymphovascular space invasion (LVSI), but the studies that evaluated stage IA1 treatment options have lack of homogeneity regarding variables such as LVSI, depth of invasion, histologic type, and surgical margin status. The aim is to evaluate recurrence rate and risk factors in women stage IA1 CC without LVSI managed conservatively. Methodology Retrospective review of women with stage IA1 squamous CC who underwent cold knife cone or loop electrosurgical excision procedure, between 1994 and 2015, at a gynecologic oncology center in Southern Brazil. Age at diagnosis, pre-conization findings, conization method, margin status, residual disease, recurrence and survival rates were collected and analyzed. Results 26 women diagnosed with stage IA1 squamous CC without LVSI underwent conservative management and had ≥12 months follow-up. The mean age at diagnosis was 40.9 years. Median first intercourse occurred at age 16 years, 11.5% were nulliparous and 30.8% were current or past tobacco smokers. The mean follow-up was 44.6 months. There was one Human immunodeficiency virus (HIV)-positive patient diagnosed with cervical intraepithelial neoplasia grade 2 at 30 months after surgery. However, there were no patients diagnosed with recurrent invasive cervical cancer and there were no deaths due to cervical cancer or other causes in the cohort. Conclusion No recurrence of cancer was observed in mean follow-up of 44.6 months. One recurrence of cervical intraepithelial neoplasia occurred in HIV positive patient. A good outcome was noted in women stage IA1 CC without LVSI and negative margins who were managed conservatively. The strengths of our study include a homogeneous group of patients from a developing country within the perspective of surgical conservative treatment and a long period follow-up.