The Rationale for Hysterectomy after Uterine Cervix Conization

Our aim was to investigate the incidence, most common indications and adequacy of hysterectomy after uterine cervix conization. We have retrospectively analyzed the patients with conization treated at the Clinic of Gynecology and Obstetrics in Niš from 2000 to 2004. There were 306 uterine cervix conizations performed in total. In 54 patients, on the average in 17.64% hysterectomy was done after conization. Out of all the indications for hysterectomy after conization, the most common was microinvasive and invasive uterine cervix carcinoma in 59.25% and positive conization margins in 27.77%. The analysis of histopathologic findings obtained at hysterectomy following conization demonstrated that hysterectomy was too extensive in 70,37% of the cases, since in 27.77% the findings were benign and in 42.59% of the cases cervical intraepithelial neoplasia (CIN) was identified, for which surgical reintervention would have been sufficient. In the cases of microinvasive and invasive carcinoma, hysterectomy (radical) was demonstrated to be adequate (and that is of statistical significance), since in 80% the findings were identical at hysterectomy. Conclusion. The most common indication for hysterectomy after conization is microinvasive and invasive uterine cervix carcinoma, immediately followed by positive conization margins. Hysterectomy is not an adequate surgical reintervention for positive conization margins, since in 70.37% of the cases it proved to be a too extensive surgery.