Introduction

Early management of high-grade cervical intraepithelial neoplasia is one of the key steps in cervical cancer prevention after vaccination and screening. It relies on lesion removal by surgical excision, and the French National Cancer Institute (INCa) in 2016 recommend using a loop electro excision procedure (LEEP). However, the laser excision method seems to be as effective with similar rates of negative excision margins and postoperative clearance of HPV.

Objective

The main objective of our study was to compare the laser excision method to LEEP by evaluating the quality of the surgical margins. We also studied factors associated with the status of the margins and the depth of cones.

Methods

We conducted a retrospective unicentric study between 2009 and 2017.

Results

Two hundred and thirty-one patients were included: 154 laser excisions and 77 LEEP. Negative surgical margin was achieved in 69.5 % of laser excisions and 72.7 % of LEEP (p = 0.649). Concerning factors predicting margin status, only a greater cone depth was associated with negative margins (OR: 0.91 (95 %CI: 0.84, 0.89); p = 0.02). The surgical technique was not found to be associated with the status of the margins (OR: 0.85 (95 %CI: 0.46,1.56); p = 0.61). Concerning factors predicting cone depth, only the LEEP was associated with a shorter cone depth (OR: 0.24 (95 %CI: 0.08, 0.69); p 0.008). Significant results are based on univariate analysis.

Conclusion

No difference was found between the two technics concerning the rate of negative margins. However, LEEP seems to be associated with shorter cone depth in this study.

中文翻译：

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高级别宫颈肿瘤患者行环形电切术（LEEP）和激光切除术后的边缘状态

 介绍

高级别宫颈上皮内瘤变的早期治疗是继疫苗接种和筛查之后预防宫颈癌的关键步骤之一。它依靠手术切除来去除病灶，法国国家癌症研究所 (INCa) 在 2016 年推荐使用环形电切除术 (LEEP)。然而，激光切除方法似乎同样有效，切除边缘阴性率和术后 HPV 清除率相似。

 客观的

我们研究的主要目的是通过评估手术切缘的质量来比较激光切除方法与 LEEP。我们还研究了与边缘状态和视锥细胞深度相关的因素。

 方法

我们在 2009 年至 2017 年间进行了一项回顾性单中心研究。

 结果

共纳入 231 名患者：154 名激光切除患者和 77 名 LEEP 患者。 69.5% 的激光切除术和 72.7% 的 LEEP 手术切缘达到阴性 (p = 0.649)。关于预测边缘状态的因素，只有较大的锥体深度与负边缘相关（OR：0.91（95％CI：0.84，0.89）；p = 0.02）。未发现手术技术与切缘状态相关（OR：0.85（95%CI：0.46,1.56）；p = 0.61）。关于预测锥体深度的因素，只有 LEEP 与较短的锥体深度相关（OR：0.24（95%CI：0.08，0.69）；p < 0.008）。显着结果基于单变量分析。

 结论

就负利润率而言，两种技术之间没有发现差异。然而，在本研究中，LEEP 似乎与较短的锥体深度有关。