Factors Affecting Resection Margin After Cervical Lesion Cone Resection And Follow-up Analysis Of Patients With Positive Resection Margin

Objective:1.To explore the related factors that affect the marginal status of patients with cervical lesions after cone resection.2.To explore the related factors that affect the residual disease in patients with positive margins after conical incision.Method:1.From January 1,2012 to December 31,2018,due to HSIL and minimally invasive cancer,1137 patients who underwent cervical cone resection for the first time in our hospital,including 115 patients with positive resection margin and negative margin resection.1022 cases.The age,menopausal status,parity,range and grade of lesions,recurrent gland,HR-HPV infection type,Cone cutting method and depth and other factors were retrospectively analyzed for correlation with postoperative margin status.2.Of the 115 patients who were positive for the first conic resection,58 patients underwent surgical treatment in our hospital within 6 months.Postoperatively,29 cases of residual disease and 29 cases of residual disease were not found.Factors such as patient age,menopausal status,parity,range and grade of lesions,glandular glands,HR-HPV infection type,cone cutting style and depth,affected area and extent of resection margins,and their correlation with residual disease were analyzed.Result:1.The positive rate of resection margin in patients with cervical lesions was 10.11%(115/1137).Univariate analysis: lesion range>2 quadrants(P= 0.000,χ2=21.864),minimally invasive carcinoma(P=0.000,χ2=20.379),recurrent glands(P=0.000,χ2=46.973),HR-HPV16/18 infection(P=0.000,χ2=13.088),LEEP(P=0.000,χ2=14.100),taper depth <2cm(P=0.000,χ2=17.091)were the risk factors for positive margin.Multivariate analysis: minimally invasive carcinoma(P=0.000,OR=2.713,95%CI=1.573-4.678),recurrent gland(P=0.000,OR=7.914,95%CI=3.903-16.044),HPV16/18 infection(P=0.014,OR=1.815,95%CI=1.131-2.915),taper depth <2cm(P= 0.001,OR=3.486,95%CI=1.636-7.426)were independent risk factors for positive margin.2.Residual patients with positive resection margins found that the residual disease rate was 50%(29/58).Univariate analysis: minimally invasive carcinoma(P=0.029,χ2=4.687),medial resection margin involvement(P= 0.029,χ2=4.687),multiple resection margin involvement(P=0.017,χ2= 5.586)were patients with positive margins Risk factors for postoperative lesions.Multivariate analysis: Multipoint involvement of the resection margin(P=0.040,OR=3.507,95%CI=1.057-11.636)was an independent risk factor for residual lesions after cervical cone resection in patients with positive resection margin.Conclusion:1.Minimal invasive cancer,recurrent gland,HPV16/18 infection,and cone cutting depth <2cm are independent risk factors for positive margin.Positive width and depth of the margin should be increased during surgery to reduce the positive margin rate and reduce residual disease.2.Multi-point involvement of the resection margin is an independent risk factor for residual lesions in patients with positive resection margin.For these patients,especially those who are older,have no fertility requirements,have a wide range of lesions,and have a high level of disease(microinvasive cancer),Two surgeries are recommended,and those who refuse surgery are advised to follow up closely to detect lesions in a timely manner.