Effect of conization, manipulator use, and their interaction on recurrence after radical hysterectomy for cervical cancer: A multicenter retrospective analysis

Objective: To evaluate the effect of conization, manipulator use, and their interaction on recurrence for patients who underwent radical hysterectomy for cervical cancer. Methods: We conducted a multicenter retrospective cohort study of 761 patients who underwent radical hysterectomy for cervical cancer with minimally invasive surgery (MIS; n = 445; laparoscopic or robotic) or open surgery (n = 316) from 2006 to 2018. All patients had FIGO (International Federation of Gynecology and Obstetrics) 2009 stage I tumors. Data were abstracted from electronic health records. Patients with unclear conization or manipulator data were excluded. Patient follow-up data were analyzed for the first 3 years after surgery. Results: Patients with conization had a reduced risk of recurrence independent of surgical approach (MIS: hazard ratio [HR], 0.15; 95 % CI, 0.06–0.34; open: HR, 0.31; 95 % CI, 0.12–0.83). For patients in the MIS group with conization, manipulator use was not associated with an increased risk of recurrence (HR, 2.11; 95 % CI, 0.07–64.80). However, for patients in the MIS group without conization, manipulator use was associated with a significantly increased risk of recurrence (HR, 3.95; 95 % CI, 1.27–12.35). No difference in recurrence was observed for patients with conization, regardless of manipulator use or the presence of residual tumor in the hysterectomy specimen. Conclusions: Conization is an independent factor associated with a decreased risk of recurrence, regardless of manipulator use and surgical approach. Manipulator use is an independent factor associated with an increased risk of recurrence, but only for patients with no conization and tumors 2 cm or larger.