Objective To compare the resection margin (RM) status and postoperative severe hemorrhage (SH) using different loop electrosurgical excision procedure (LEEP) techniques for cervical intraepithelial neoplasia (CIN) 2/3 treatment.
Study Design We retrospectively reviewed 278 patients who underwent LEEPs for CIN 2/3 treatment at our institute between 2005–2014. In type A surgery (N=148), a ring-shaped loop was used. If the first pass failed to remove the entire lesion, separate loop excisions for the intracervical portion were performed. In type B surgery (N=130), a right-angled triangular loop in a single pass was used. Surgical outcomes and postoperative SH were compared between the two groups. Logistic regression analysis was performed to identify the independent predictors of RM status.
Results The mean LEEP depth was larger after type A surgery (2.2 vs 2.0 cm, respectively; P=0.04). Type B surgery showed lower rate of 30-day postoperative hemorrhage (13.8% vs 26.4%, P <0.05) and higher rate of negative RM (68.9% vs 82.3%, P<0.05). Multivariate analysis identified the surgery type [P=0.01, OR=0.45 (0.24-0.83)] and a postoperative pathological diagnoses of CIN3 [P=0.01, OR=2.53 (1.22-5.26)] as independent risk factors for positive RM.
Conclusions LEEPs using a right-angled triangular loop could reduce positive RMs.
Keywords cervical intraepithelial neoplasia, LEEP, resection margin, postoperative hemorrhage