Jiang Yanming, Chen Changxian, Li Li
Department of Gynecology, Liuzhou People's Hospital, Liuzhou, China.
Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.
PLoS One. 2017 Jan 26;12(1):e0170587. doi: 10.1371/journal.pone.0170587. eCollection 2017.
The objective of this systematic review was to conduct a more comprehensive literature search and meta-analysis of original studies to evaluate the efficacy and safety of the loop electrosurgical excision procedure (LEEP) versus cold-knife conization (CKC) in conservative surgical treatment of cervical adenocarcinoma in situ (ACIS) for women who have not completed childbearing.
Systematic searches were conducted in the PUBMED, EMBASE, Cochrane, and China National Knowledge Infrastructure (CNKI) databases to identify all potential studies involving patients with ACIS treated with LEEP versus CKC published until December 2015.
Eighteen retrospective studies were included in this systematic review. All the 18 included studies reported the rate of positive margins, and the results of the individual studies varied. The positive margins were 44% (267/607) after LEEP and 29% (274/952) after CKC. The pooled meta-analysis exhibited significantly different outcome (RR, 1.55; 95% CI, 1.34-1.80, P<0.00001) without significant heterogeneity (P = 0.34). The residual rate following LEEP was 9.1% (17/186) and 11% (39/350) after CKC in re-cone or hysterectomy cases. Recurrent ACIS following LEEP was reported in 10 of 142 (7.0%) cases compared to 10 of 177 (5.6%) cases following CKC. There were no significant differences in the residual rate (RR, 1.02; 95% CI, 0.60-1.72, P = 0.95) or recurrence rate (RR, 1.13; 95% CI, 0.46-2.79; P = 0.79) between the two procedures.
The present systematic review demonstrates that both LEEP and CKC are safe and effective for the conservative treatment of ACIS. LEEP appears to be as equally effective as CKC regarding the residual and recurrence rates. Due to the findings showing that LEEP achieves comparable oncologic outcomes with fewer obstetric complications to that of CKC, LEEP may be the preferred option in patients whose fertility preservation is important. However, further prospective studies with a larger sample size and longer follow-up periods are needed to establish the superiority of either procedure.
本系统评价的目的是进行更全面的文献检索和对原始研究的荟萃分析，以评估环形电切术（LEEP）与冷刀锥切术（CKC）在未完成生育的女性原位宫颈腺癌（ACIS）保守手术治疗中的疗效和安全性。
在PubMed、EMBASE、Cochrane和中国知网（CNKI）数据库中进行系统检索，以识别所有涉及2015年12月前发表的接受LEEP与CKC治疗的ACIS患者的潜在研究。
本系统评价纳入了18项回顾性研究。所有18项纳入研究均报告了切缘阳性率，各研究结果各异。LEEP术后切缘阳性率为44%（267/607），CKC术后为29%（274/952）。汇总的荟萃分析显示结果有显著差异（RR，1.55；95%CI，1.34 - 1.80，P<0.00001），且无显著异质性（P = 0.34）。在再次锥切或子宫切除病例中，LEEP术后残留率为9.1%（17/186），CKC术后为11%（39/350）。LEEP术后142例中有10例（7.0%）报告复发性ACIS，CKC术后177例中有10例（5.6%）。两种手术在残留率（RR，1.02；95%CI，0.60 - 1.72，P = 0.95）或复发率（RR，1.13；95%CI，0.46 - 2.79；P = 0.79）方面无显著差异。
本系统评价表明，LEEP和CKC在ACIS的保守治疗中均安全有效。在残留率和复发率方面，LEEP似乎与CKC同样有效。由于研究结果表明LEEP在肿瘤学结局上与CKC相当，但产科并发症更少，对于生育保留很重要的患者，LEEP可能是首选。然而，需要进一步进行更大样本量和更长随访期的前瞻性研究来确定两种手术的优越性。
