The research was set out to determine whether or not pre-operative conization improved disease-free survival (DFS) in early-stage cervical cancer. This population-based cohort study used data from clinical cancer registries to assess the effect of conization prior to radical hysterectomy on the disease-free survival (DFS) of women diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IA1-IB1 cervical cancer between January 2010 and December 2015. This study included 235 patients who met the inclusion criteria out of a total of 993 who had data available for analysis. The median time of observation was 5.4 years. About 48 recurrences (11.9%) were recorded throughout the study period. FIGO stage IB1 individuals were affected in all of these cases. Patients with FIGO IB1 tumors less than 2 cm were further analyzed and separated into 2 groups. Pre-operative conization was associated with a reduced rate of recurrence (P=0.007), with only 3(5.2%) recurrences in this group (CO) compared to 25 recurrences (21.0%) in the group without conization (NCO) preceding radical hysterectomy. DFS was calculated as 79.0% in NCO and 94.8% in CO (P=0.008). Conization remained a favorable prognostic factor for DFS after accounting for other prognostic variables (HR 0.27; 95% CI 0.08-0.93, P=0.037). In the multivariate analysis, lymph node involvement was the single negative predictor (HR 4.38; 95% CI 1.36-14.14, P=0.014). In early-stage cervical cancer, pre-operative conization improves DFS regardless of the surgical method taken.