No clear evidence to show any one optimal surgical technique is superior for treating pre-cancerous cervix abnormalities

Martin-Hirsch PPL, Paraskevaidis E, Bryant A, Dickinson HO, Keep SL

Published Online:

June 16, 2010

Cervical pre-cancer (cervical intraepithelial neoplasia) can be treated in different ways depending on the extent and nature of the disease. Less invasive treatments that do not require a hospital stay may be used. A general anaesthetic is occasionally needed, especially if the disease has spread locally, early invasion is suspected or previous out-patient treatment has failed. Surgery can be done with a knife, cryotherapy (freezing the abnormal cells), laser or cutting with a loop (an electrically charged wire). This review found there was not enough evidence to confidently select the most effective technique and that more research is needed.

Abstract (click to read)

Background:

Cervical intraepithelial neoplasia (CIN) is the most common pre-malignant lesion. Atypical squamous changes occur in the transformation zone of the cervix with mild, moderate or severe changes described by their depth (CIN 1, 2 or 3). Cervical intraepithelial neoplasia is treated by local ablation or lower morbidity excision techniques. Choice of treatment depends on the grade and extent of the disease.

Objectives:

To assess the effectiveness and safety of alternative surgical treatments for CIN.

Search strategy:

We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE and EMBASE (up to April 2009). We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies.

Selection criteria:

Randomised controlled trials (RCTs) of alternative surgical treatments in women with cervical intraepithelial neoplasia.

Data collection and analysis:

Two review authors independently abstracted data and assessed risks of bias. Risk ratios that compared residual disease after the follow-up examination and adverse events in women who received one of either laser ablation, laser conisation, large loop excision of the transformation zone (LLETZ), knife conisation or cryotherapy were pooled in random-effects model meta-analyses.

Main results:

Twenty-nine trials were included. Seven surgical techniques were tested in various comparisons. No significant differences in treatment failures were demonstrated in terms of persistent disease after treatment. Large loop excision of the transformation zone appeared to provide the most reliable specimens for histology with the least morbidity. Morbidity was lower than with laser conisation, although the trials did not provide data for every outcome measure. There were not enough data to assess the effect on morbidity when compared with laser ablation.

Authors' conclusions:

The evidence suggests that there is no obvious superior surgical technique for treating cervical intraepithelial neoplasia in terms of treatment failures or operative morbidity.

This record should be cited as:

Martin-Hirsch PPL, Paraskevaidis E, Bryant A, Dickinson HO, Keep SL. Surgery for cervical intraepithelial neoplasia. Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD001318. DOI: 10.1002/14651858.CD001318.pub2

Assessed as up to date:

May 11, 2010

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Gynaecological Cancer Group

Health topics:

Cancer > Gynaecological > Cervix

Gynaecology > Cancer > Cervix

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

No clear evidence to show any one optimal surgical technique is superior for treating pre-cancerous cervix abnormalities

More like this

Copyright © 2012 - The Cochrane Collaboration