Impact of endocervical surgical margin in the treatment of dysplastic cervical lesions

Abstract

Aim of the study: To describe the impact of endocervical margin involvement after cervical CO2 laser conization and to report the risks factors for positive margin and patterns of subsequent management. Methods: Clinical and pathological data of 2863 patients who underwent treatment were retrospectively reviewed. Data were obtained from consecutive patients treated from January 1990 to June 2019 at the Department of Gynecology and Obstetrics of Spedali Civili of Brescia. We used Chi-square test with significance defined at p < 0.05 to explore the results. Further, we described the “cylindrical” technique for cervical CO2 laser conization. Results: Endocervical margin involvement was found in 152 patients (5.3%), while 1795 patients with negative endocervical margin were available for followup (62.7%), the remaining were lost to follow-up. The risk factors for endocervical margin involvement were the grade of the lesion (p < 0.001), age (p < 0.001), extension to the cervical canal (p < 0.001); presence of moderate intraoperative bleeding (p = 0.04) and lack of preoperative antibiotic prophylaxis (p = 0.05). Among patients with positive endocervical margin, 21 patients (13.8%) with invasive lesion underwent definitive treatment (Group 1), 30 patients (Group 2) underwent hysterectomy or reconization, while intensive followup was offered to 101 patients (Group 3). Only 91 patients were available for follow-up in Group 3. The treatment failure/recurrence in the latter group (n = 91) of patients was higher when compared to patients (n = 1795) with negative endocervical margin (14.3% versus 6.7%; p = 0.01). Conclusion: Endocervical margin involvement after CO2 laser conization is a predictor of treatment failure/recurrence of disease. Risk factors for endocervical margin involvement should be subject of prospective multicenter studies.