Meta-analysis of cold-knife conization versus loop electrosurgical excision procedure for cervical intraepithelial neoplasia

Abstract

Objective

This meta-analysis aimed to compare the superiority of loop electrosurgical excision procedure (LEEP) or large loop excision of the transformation zone (LLETZ) versus cold-knife conization (CKC) in the surgical treatment of cervical intraepithelial neoplasia (CIN).

Methods

Systematic searches were performed in the MEDLINE, EMBASE, Cochrane databases, and the China National Knowledge Infrastructure Databases to identify all potential articles involving patients with CIN treated with LEEP/LLETZ or CKC published up to February 2016. Risk ratios (RRs) or weighted mean difference (MD) with a 95% confidence interval (95% CI) were calculated.

Results

Seven randomized controlled trials, one prospective cohort study, and twelve retrospective cohort studies were included in this meta-analysis. There were no significant differences following LEEP/LLETZ compared with CKC in recurrence rate (RR =1.75, 95% CI =0.99–3.11, P=0.06), positive margin rate (RR =1.45; 95% CI =0.85–2.49, P=0.17), residual disease rate (RR =1.15, 95% CI =0.73–1.81, P=0.48), secondary hemorrhage (RR =1.16, 95% CI =0.74–1.81; P=0.46), or cervical stenosis. Moreover, subgroup analyses based on randomized trials also revealed that no statistical significance was observed in the above outcomes. However, women treated with CKC had a significantly deeper cervical cone than those treated with LLETZ/LEEP (MD =−5.71, 95% CI =−7.45 to −3.96; P<0.001).

Conclusion

LEEP/LLETZ is as effective as CKC with regard to recurrence rate, positive margin rate, residual disease rate, secondary hemorrhage, and cervical stenosis for the surgical treatment of CIN. Further large-scale studies are needed to confirm our findings.