Conization by Carbon Dioxide Laser or Cold Knife in the Treatment of Cervical Intra‐Epithelial Neoplasia

Abstract

In a randomized trial concerning 123 women with CIN, 59 were treated with laser conization under colposcope without further hemostatic remedy and 64 with cold knife conization guided by Schiller's iodine dyeing supported by side sutures, vaginal packing and postoperative oral administration of tranexam acid. Follow-up with colposcopy and cytology was done 3 and 12 weeks post-conization and then every 6 months. The average follow-up period was 36 months (28-48). Peroperative bleeding was rather less pronounced in the laser group. Postoperatively, however, bleeding requiring treatment was significantly less common in the laser group (5%) than in the cold knife group (17%). The recurrence rate of CIN was 7% in the laser group and 10% in the knife group. Stenosis of the cervical canal developed in 7% of the patients in the laser group and in 3.5% in the knife group. After 12 weeks the squamocolumnar junction was visible in its full extent in 66% of the laser treated patients compared with 38% of the cold knife treated patients. It is concluded that laser conization is a safe procedure even without hemostatic procedures other than the coagulation abilities of the laser beam itself, as used in this work.

Surgery for cervical intraepithelial neoplasia

“…Allocation-Concealment of allocation was satisfactory in 11 trials (Alvarez 1994;Cherchi 2002;Chirenje 2001;Crompton 1994;Dey 2002;Giacalone 1999;Gilbert 1989;Healey 1996;Oyesanya 1993;Panoskaltsis 2004a;Partington 1989) but was not reported in any of the other 18 trials.…”

“…Primary haemorrhage: Meta-analysis of two trials (Bostofte 1986;Kristensen 1990), assessing 316 participants, found no statistically significant difference between laser conisation and knife conisation in the risk of primary haemorrhage (RR 0.53, 95% CI 0.18 to 1.54). The percentage of the variability in effect estimates that was due to heterogeneity rather than by chance may represent moderate heterogeneity (I 2 = 40%).…”

“…to cryotherapy (Berget 1987;Jobson 1984;Kirwan 1985;Kwikkel 1985;Mitchell 1998;Townsend 1983), knife conisations (Bostofte 1986;Kristensen 1990;Larsson 1982;Mathevet 1994), LLETZ using either conisation techniques (Crompton 1994;Mathevet 1994;Oyesanya 1993;Paraskevaidis 1994;Santos 1996;Vejerslev 1999) or laser ablation (Alvarez 1994;Dey 2002;Mitchell 1998) and the different laser techniques (ablation versus conisation (Partington 1989).…”

“…Nine studies included knife conisation as part of their methodology, including comparisons with loop excision (Duggan 1999;Giacalone 1999;Mathevet 1994;Takac 1999), laser surgery (Bostofte 1986;Kristensen 1990;Larsson 1982;Mathevet 1994) or NETZ (Sadek 2000) with or without the insertion of haemo-static sutures (Gilbert 1989;Kristensen 1990).…”

“…Sequence generation-Adequacy of randomisation was confirmed in 14 trials (Alvarez 1994;Cherchi 2002;Chirenje 2001;Crompton 1994;Dey 2002;Duggan 1999;Giacalone 1999;Healey 1996;Mathevet 1994;Mitchell 1998;Panoskaltsis 2004a;Santos 1996;Schantz 1984;Vejerslev 1999), where an appropriate method of sequence generation was used to assign women to treatment groups. The method of randomisation was not reported in the other 15 trials.…”