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European Journal of Gynaecological Oncology  2020, Vol. 41 Issue (6): 931-938    DOI: 10.31083/j.ejgo.2020.06.2122
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Impact of endocervical surgical margin in the treatment of dysplastic cervical lesions
Serena Loda1, Federica Salinaro1, Claudio Schreiber1, Giuseppe Ciravolo1, GiancarloTisi1, Federico Ferrari1, Tiziano Maggino2, *(), Franco Odicino1, Enrico Sartori1
1Department of Gynecology and Obstetrics, Spedali Civili of Brescia, University of Brescia, Brescia
2Obstetrics and Gynecology Unit, “Dell’Angelo” General Hospital, Mestre, Venice, Italy
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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 follow-up (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 follow-up 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.
Key words:  Cervical dysplasias      Endocervical margin involvement      CO2 laser conization     
Submitted:  07 May 2020      Accepted:  20 August 2020      Published:  15 December 2020     
*Corresponding Author(s):  TIZIANO MAGGINO     E-mail:

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Serena Loda, Federica Salinaro, Claudio Schreiber, Giuseppe Ciravolo, GiancarloTisi, Federico Ferrari, Tiziano Maggino, Franco Odicino, Enrico Sartori. Impact of endocervical surgical margin in the treatment of dysplastic cervical lesions. European Journal of Gynaecological Oncology, 2020, 41(6): 931-938.

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