Article
Large loop versus straight-wire excision of the transformation zone for treatment of cervical intraepithelial neoplasia: a randomised controlled trial of electrosurgical techniques
Registro en:
CAMARGO, M. J. et al. Large loop versus straight-wire excision of the transformation zone for treatment of cervical intraepithelial neoplasia: a randomised controlled trial of electrosurgical techniques. BJOG., Oxford, v. 122, p. 552–557, 2015
10.1111/1471-0528.13200
Autor
Camargo, M. J.
Russomano, Fábio Bastos
Tristão, M. A.
Huf, G.
Prendiville, W.
Resumen
ObjectiveTo compare two electrosurgical techniques, straight-wire
excision of transformation zone (SWETZ) with large loop excision
of transformation zone, as a cone procedure (LLETZ-cone), for the
treatment of cervical intraepithelial neoplasia (CIN), when disease is
present at the cervical canal.
DesignRandomised controlled trial.
SettingTwo public hospitals, one in Rio de Janeiro, Brazil and
one in Dublin, Ireland.
PopulationOne hundred and three women with indication to
treat CIN located at cervical canal.
MethodsWomen were randomised to receive LLETZ-cone or
SWETZ.
OutcomesMain outcome was the incidence of complete excision
of disease at endocervical margin of the surgical specimen.
Secondary outcomes were complete excision at ectocervical and
stromal margins, time to complete the procedure, specimen
fragmentation, blood loss and death after 1 year.
ResultsFifty-two women were allocated to LLETZ-cone and 51
to SWETZ. Ten women were lost for main outcome because of
damaged specimens. Forty-two women in the LLETZ-cone
group had free endocervical margin versus 43 women in the
SWETZ group (relative risk 1.04, 95% confidence interval [95%
CI] 0.87–1.25;P=0.64). For secondary outcomes related to
margins, we observed a relative risk of 1.15 (95% CI 0.95–1.39;
P=0.15) for ectocervical free margin. For free stromal margin,
the relative risk was 1.07 (95% CI 0.89–1.29;P=0.47). No
death was observed.
ConclusionsThis study was inconclusive; SWETZ and LLETZ-cone were equally effective to treat endocervical disease, with
no difference in protecting against margin involvement. Higher,
but not severe, blood loss and longer surgical time were
observed in the SWETZ group.