CO2 laser cylindrical excision or standard re-conization for persistent-recurrent high-grade cervical intraepithelial neoplasia (HG-CIN) in women of fertile age.

Abstract

AIM:

To investigate the therapeutic efficacy of cylindrical or cone-shaped excision performed by laser CO2 in the conservative management of persistent-recurrent high-grade cervical intraepithelial neoplasia (HG-CIN) in women of fertile age.

PATIENTS AND METHODS:

Ninety-four premenopausal patients with persistent-recurrent HG-CIN had undergone re-conization or cylindrical excision according to the time of reappearance of the disease. The length of the procedures, intra- and postoperative complications, height of the excised specimens, final histological findings and follow-up data were retrospectively evaluated.

RESULTS:

Fifty-five (58.5%) persistent and 39 (41.5%) recurrent cases had undergone cylindrical excision and standard re-conization respectively. All the treatments were successfully performed in an out-patient setting under local anesthesia with no differences in term of operative time, height of removed specimens, intra- and postoperative complications between the two groups. Definitive histology confirmed HG-CIN in 95.7% of the cases and FIGO Stage Ia1 cervical cancer (negative lymph vascular space involvement, LVSI) in 4.3% of the cases. The endocervical margins were involved in 3.6% of the cylindrical (persistent) and in 17.9% of the cone-shaped (recurrent) specimens (p = 0.03). The overall cure rate after a median follow-up time of 54 months (range 10-196) was 91.5%. A third excisional procedure was performed in 8 cases of persistent-recurrent HG-CIN with a disease-free subsequent follow-up of 38 months (range 6-108).

CONCLUSION:

Cylindrical or conical re-excision performed by CO2 laser according to the time of reappearance of the disease seems to be a promising conservative approach for persistent-recurrent HG-CIN even though further randomised prospective studies are needed to confirm the long-term efficacy and reproductive outcomes.

• Authors: Massimiliano Fambrini, Carlo Penna, Annalisa Pieralli, Maria Grazia Fallani, Karin L Andersson, Virginia Lozza, Gianfranco Scarselli, Mauro Marchionni
• Journal: Anticancer research (Anticancer Res) 2008 Nov-Dec Vol. 28 Issue 6B Pg. 3871-5 ISSN: 0250-7005 [Print] Greece
• PMID: 19192643 (Publication Type: Journal Article)

Topics

• Adult
• Conization (methods)
• Female
• Fertility
• Humans
• Laser Therapy (methods)
• Lasers, Gas
• Middle Aged
• Neoplasm Recurrence, Local (surgery)
• Retrospective Studies
• Uterine Cervical Neoplasms (surgery)
• Young Adult
• Uterine Cervical Dysplasia (surgery)