Inpatient and outpatient loop electrosurgery excision procedure for cervical intraepithelial neoplasia: a retrospective analysis

Abstract

Purpose To determine whether the outpatient loop electrosurgical excision procedure (LEEP) conization (out-LEEP) is as effective and safe as inpatient LEEP conization (in-LEEP) with regard to the complete removal of cervical dysplasia, recurrence-free survival and post-operative morbidity. Methods 233 patients were included in this retrospective cohort study from January 2002 to December 2007. 181 had outpatient treatment and 52 inpatient treatment. We used Mann-Whitney U test, two-sided Fisher's exact test, Chi-square test, log rank test and Kaplan-Meier curve. Results Incomplete excision was found in 16/52 (30.8%) cases in the inpatient group and 46/181 (25.4%) in the outpatient group (P = 0.48). Six patients had post-operative complications: two cases of secondary haemorrhage in each group (in-LEEP 3.8%, out-LEEP 1.1%, P = 0.22) and two cases of cervical stenosis amongst inpatients (3.8%, P = 0.049). Alteration of specimen by thermal artifact were reported in 4/52 (7.7%) of in-LEEP cones and 10/181 (5.5%) of out-LEEP cones (P = 0.52). Measurements of cones in both groups were comparable with a mean depth of 9.35 mm (±5.5 mm) and 8.4 mm (±3.4 mm), respectively. Conclusion Our results suggest that efficacy and safety of ambulatory LEEP conization is comparable as in inpatient procedure.

Durability of response to VGX-3100 treatment of HPV16/18 positive cervical HSIL

“…In fact, a non-surgical treatment alternative avoids the alteration of cervical anatomy, thereby enabling a therapeutic approach that preserves reproductive health for young women 4 and also avoids the adverse events specifically associated with surgical treatment for cervical HSIL. 4,[13][14][15][16][17]…”

The Role of Surgeonsʼ Colposcopic Experience in Obtaining Adequate Samples by Large Loop Excision of the Transformation Zone in Women of Reproductive Age

“…Adequate management of cervical dysplasia is an important step in cervical cancer prevention [10]. The cure rates following LLETZ have been broadly investigated with respect to patientsʼ age, parity, size and grade of lesion, cone size and volume, as well as the use of various LLETZ technique modifications [2,4,[11][12][13]. However, data on surgeonsʼ colposcopic experience and its influence on specimen quality, the presence and diagnostic significance of the artifacts have been inadequately studied.…”

“…Large loop excision of the transformation zone (LLETZ) is a commonly used technique for managing women with pathological changes on the uterine cervix, which has gained worldwide acceptance due to its numerous advantages [1][2][3][4]. Unlike ablative methods, LLETZ allows histological examination of the excised tissue [1][2][3][4]. However, LLETZ causes thermal damage of specimens [5], due to the use of electricity, which simultaneously cuts and coagulates the tissue [6].…”

Loop electrosurgical excision procedure combined with cold coagulation for cervical intraepithelial neoplasia and adenocarcinoma in-situ: a feasible treatment with a low risk of residual/recurrent disease

“…Moreover, the authors suggested that treatment of CIN using LEEP and CC combined could have less abnormal cervical cytologic findings in women who had incomplete excision of their initial lesion compared to LEEP alone. Meanwhile, previous studies reported positive margin rates of 16 to 46.3% after LEEP [ 7 , 11 – 13 ]. Although several earlier studies have reported that replicate surgical specimens of patients with involved resection margins (RMs) frequently have no residual neoplasia [ 14 – 17 ], the margin status of conization specimens is considered to be an important predictor of residual neoplasia [ 18 , 19 ].…”