Long-term Outcomes of a Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia in a High Incidence Country

Aim: To evaluate the operative, oncologic and obstetric outcomes of the loop electrosurgical excision procedure(LEEP) in cases with cervical neoplasia. Materials and
Methods: A retrospective cohort study was conducted onpatients who were suspected of cervical neoplasia and therefore undergoing LEEP at Siriraj Hospital, MahidolUniversity, Thailand, during 1995-2000. Outcome measures included operative complications in 407 LEEPpatients and long-term outcomes in the 248 patients with cervical intraepithelial neoplasia (CIN) who weretreated with only LEEP.
Results: There were 407 patients undergoing LEEP; their mean age was 39.7±10.5years. The histopathology of LEEP specimens revealed that 89 patients (21.9%) had lesions ≤CIN I, 295 patients(72.5%) had CIN II or III, and 23 patients (5.6%) had invasive lesions. Operative complications were found in15 patients and included bleeding (n=9), and infection (n=7). After diagnostic LEEP, 133 patients underwenthysterectomy as the definite treatment for cervical neoplasia. Of 248 CIN patients who had LEEP only, seven(2.8%) had suffered recurrence after a median of 16 (range 6-93) months; one had CIN I, one had CIN II, andfive had CIN III. All of these recurrent patients achieved remission on surgical treatment with re-LEEP (n=6) orsimple hysterectomy (n=1). A significant factor affecting recurrent disease was the LEEP margin involved withthe lesion (p=0.05). Kaplan-Meier analysis showed 5-year and 10-year disease-free survival (DFS) estimates of99.9%. Twelve patients became pregnant a total of 14 times, resulting in 12 term deliveries and two miscarriages- one of which was due to an incompetent cervix.
Conclusions: LEEP for patients with cervical neoplasia deliversfavorable surgical, oncologic and obstetric outcomes.