Abstract
ObjectiveThe objective of this systematic review was to conduct a more comprehensive literature search and meta-analysis of original studies to evaluate the efficacy and safety of the loop electrosurgical excision procedure (LEEP) versus cold-knife conization (CKC) in conservative surgical treatment of cervical adenocarcinoma in situ (ACIS) for women who have not completed childbearing.MethodsSystematic searches were conducted in the PUBMED, EMBASE, Cochrane, and China National Knowledge Infrastructure (CNKI) databases to identify all potential studies involving patients with ACIS treated with LEEP versus CKC published until December 2015.ResultsEighteen retrospective studies were included in this systematic review. All the 18 included studies reported the rate of positive margins, and the results of the individual studies varied. The positive margins were 44% (267/607) after LEEP and 29% (274/952) after CKC. The pooled meta-analysis exhibited significantly different outcome (RR, 1.55; 95% CI, 1.34–1.80, P<0.00001) without significant heterogeneity (P = 0.34). The residual rate following LEEP was 9.1% (17/186) and 11% (39/350) after CKC in re-cone or hysterectomy cases. Recurrent ACIS following LEEP was reported in 10 of 142 (7.0%) cases compared to 10 of 177 (5.6%) cases following CKC. There were no significant differences in the residual rate (RR, 1.02; 95% CI, 0.60–1.72, P = 0.95) or recurrence rate (RR, 1.13; 95% CI, 0.46–2.79; P = 0.79) between the two procedures.ConclusionsThe present systematic review demonstrates that both LEEP and CKC are safe and effective for the conservative treatment of ACIS. LEEP appears to be as equally effective as CKC regarding the residual and recurrence rates. Due to the findings showing that LEEP achieves comparable oncologic outcomes with fewer obstetric complications to that of CKC, LEEP may be the preferred option in patients whose fertility preservation is important. However, further prospective studies with a larger sample size and longer follow-up periods are needed to establish the superiority of either procedure.
Highlights
Cervical adenocarcinoma in situ (ACIS), first described by Hepler et al in 1952 [1], is a precursor lesion for invasive cervical adenocarcinoma
Due to the findings showing that loop electrosurgical excision procedure (LEEP) achieves comparable oncologic outcomes with fewer obstetric complications to that of cold-knife conization (CKC), LEEP may be the preferred option in patients whose fertility preservation is important
The current analysis indicated that LEEP was associated with a 1.55-fold increase in the risk of positive margins compared with CKC for ACIS
Summary
Cervical adenocarcinoma in situ (ACIS), first described by Hepler et al in 1952 [1], is a precursor lesion for invasive cervical adenocarcinoma. The relative incidence of cervical adenocarcinoma has increased, accounting for 25–30% of all invasive cervical cancers [2]. This increased prevalence is found in ACIS, especially in younger women [3,4]. Conservative management options for ACIS include loop electrosurgical excision procedure (LEEP) or large loop excision of the transformation zone (LLETZ), cold-knife conization (CKC), and straight wire excision of the transformation zone (SWETZ). CKC has been the traditional procedure and is usually performed under general or regional anesthesia in a hospital setting with significantly higher costs. Compared to CKC, LEEP is usually performed under regional anesthesia in an outpatient low-cost clinic setting. Identification of the superior conservative procedure has become a hot topic in the treatment of ACIS
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