Loop Electrosurgical Excision Procedure and Cold Knife Conization: which is the best? A large retrospective study

Abstract

Objective. This study was performed to compare Loop Electrosurgical Excision Procedure (LEEP) and Cold Knife Cone (CKC) biopsy in the treatment of Cervical Intraepithelial Neoplasia (CIN) in terms of oncological outcome, effectiveness, and safety. Materials and Methods. In this retrospective observational study with a follow-up of 24 months patients with CIN at diagnosis were enrolled between January 2016 and July 2019. The primary outcome included: persistent disease rate, recurrent disease rate and cone biopsy positive margins. As secondary end point, we evaluated surgical time, bleeding within 24 hours, infections related to the procedure and cone size. Results. Ninety-six women were enrolled: 60 in LEEP group and 36 in cold knife conization group. Women undergoing LEEP procedure had similar primary oncological outcome without any statistical difference than those undergoing CKC (persistent disease 6 (10%) vs 2 (7.6%), recurrent disease 5 (8.3%) vs 4 (11.1%), positive margins 12 (20%) vs 7 (19.4%). Secondary endpoint included post-operative bleeding within 24 hours with a significant difference between two groups (4 (6.6%) in LEEP group and 8 (22.2%) in CKC group, p = 0.026). The remaining outcome measures, surgery time (200-215 sec.), cone size (0.86-1.57 cm 3 ) and post-operative infections, have no significant differences. Conclusions. The surgical conization techniques evaluated gave encouraging and balanced results in terms of oncological outcome, but the LEEP technique should be considered as the primary technique for the treatment of CIN due to its simplicity of execution, cost reduction and less postoperative complications.

The Burden of Cervical Conization in Privately Insured Young and Mid-Adult Women in the United States

“…Several reasons have been cited explaining why women remain at an increased risk of recurrence and subsequent progression to cancer: inadequate excision with positive surgical margins or persistent HPV infection, also reactivation, or HPV reinfection by exposure to an infected partner [38,39], though this paper does not capture all the reasons as our analysis is limited to the information provided by the claims data. Moreover, even though the choice of the type of conization (LEEP vs. CKC) has shown little difference in the rates of persistent or recurrent disease, [40] individual comorbidity status may have a role to play in the post-operative outcomes for women with gynecological cancers and, thus, contribute to persistent disease after the initial surgery [41].…”

Early-stage cervical cancer treatment – what’s new?

“…However, improvement of the knowledge on the treatment of early-stage cervical cancer will come from further well-designed retrospective studies. In addition, accumulating evidence suggests that preoperative conization potentially plays a protective role in patients with an IB1 tumour; in particular, patients undergoing preoperative conization (vs. cervical biopsy) were less likely to experience a recurrence [59,[72][73][74][75][76][77].…”

The role of preoperative frailty assessment in patients affected by gynecological cancer: a narrative review

“…In fact, frailty, disability and multimorbidity are very different concepts and cannot be used synonymously [13]. Many scores, with the aim of customizing the treatment, are commonly used for the assessment of frailty and there is no unanimous consensus on which is the best to use [14][15][16][17][18][19][20][21][22]. The aim of this study is to emphasize the importance of frailty by evaluating the currently available literature and to underline the use of frailty assessment tools to predict postoperative adverse outcomes and overall survival in frail patients with gynecological cancer.…”