Objective: To evaluate trend in cervical cone length and CIN linear extension in women treated in a tertiary referral centre over a 28 years period. Methods: A retrospective study including 3716 women treated with cervical conization for biopsyproven HSIL (CIN grade 2 and 3), glandular lesions and microinvasive squamous cervical cancer from 1992 to 2020. Relevant clinical and histopathological data were collected. Results: A mean cone length of 9.5 mm (SD 5.1 mm, range 1–40 mm) and CIN linear extension of 6.58 mm (SD 3.38 mm, range 1–45 mm) were found. A 35% significant decrease in cone length was observed in the 28 years period, while no differences were found in CIN extension. Furthermore, ectocervical and endocervical margin positivity rates were stable over the study period and not affected by decreasing cone length. Conclusion: The current study reported a signif-icant trend of reduction in cone length from 1992 to 2020 while margin status was unaffected. This may reflect less invasive approach and increased attention to obstetric outcomes.