Succor Cone: Is It Cervical Conization A Protective Maneuver

Introduction/Background After the publication of the LACC trial, current evidence has focused on looking for the different reasons that have led to the open approach presenting better results than minimally invasive surgery (MIS). To date, no studies have considered the possible protective effect of cervical conization (CC). Methodology Objective: The main goal of this study was to compare disease-free survival (DFS) and overall survival (OS) at 4.5 years in patients with stage IB1 cervical cancer who underwent radical hysterectomy (2013–2014) after CC vs non-CC patients. The secondary goal was to compare DFS by subgroups (tumor size and surgical approach in patients who underwent CC and those who did not) in the Propensity Matching Score (PMS) database. Methods: Taking from 1272 patients from the European database belonging to the SUCCOR study and after applying the different inclusion and exclusion criteria, we obtained 1156 patients, 733 CC patients and 423 non-CC patients. Subsequently, and after analyzing the first results, we decided to homogenize our database by means of a PMS analysis, by this way, we obtained a new balanced population of 374 patients (187 CC patients and 187 non-CC patients). Results In the general population, patients with CC present a 72% reduction in the risk of relapse compared to non-CC patients (HR: 0.28 95% CI (0.17–0.46) p = 0.000) and a 90% reduction in the risk of death (HR: 0.10 95% CI (0.03–0.33) p = 0.000), these differences may be due to the fact that both populations present differences. After homogenizing our population using the PMS, we obtained that the reduction in the risk of relapse was 65% for patients who have CC (HR: 0.35 CI 95% (0.16–0.75) p = 0.007) and 75% for the risk of death for the same cohort (HR: 0.25 95% CI (0.07–0.90) p = 0.033). Regarding the secondary objectives, we observed that the CC seems to have a protective effect in tumors between 2–4 cm (HR: 0.33 95% CI (0.11–0.99) p = 0.049). This same protective effect is observed in patients operated on by laparoscopy (HR: 0.35 95% CI (0.14–0.89) p = 0.028). Finally, the MIS patients who have CC do not present differences compared to those operated by the open approach, whether they are conized or non-conized (Log-Rank p = 0.439 and Log-Rank p = 0.346). Conclusion Patients undergoing CC have a significantly lower risk of relapse and death, this effect is more evident in those patients with 2–4 cm tumors or in those who are operated under MIS. Disclosures I have nothing to disclose.