title: Laser CO2 conization in postmenopausal age: risk of cervical stenosis and unsatisfactory follow-up.
abstract: OBJECTIVE
  To assess chances of adequate cyto-colposcopic follow-up after laser conization performed in postmenopausal screening population by the evaluation of postoperative cervical stenosis and unsatisfactory colposcopy rates.
  
  
  METHODS
  One thousand two hundred eighteen patients were submitted to laser CO2 conization for cervical intraepithelial neoplasia (CIN). Incidence and risk factors for cervical stenosis and unsatisfactory follow-up were retrospectively evaluated comparing fertile with postmenopausal patients.
  
  
  RESULTS
  Global incidences of postoperative unsatisfactory colposcopy and cervical stenosis were 46.2% and 7.1%. These rates were higher in postmenopausal patients compared with fertile ones, revealing a statistical correlation between unsatisfactory follow-up and postmenopausal status at the time of conization. Association between CIN relapse and cervical stenosis was significantly higher in postmenopausal group (66.7% vs. 8.6%; P <0.05), where two cases of recurrence were detected only after hysterectomy, because of an insurmountable cervical stenosis. Univariate and multivariate analysis revealed HRT use as the only significant factor in influencing postoperative cervical stenosis.
  
  
  CONCLUSIONS
  Conization is still considered as the standard treatment for CIN at any woman's age, when excisional management is indicated, but all postmenopausal patients should be counseled about the possibility of postoperative stenosis that could exclude an adequate follow-up, configuring a failure of the conservative treatment. HRT use is associated with a low risk of stenotic complications; therefore, if possible, users should be encouraged to continue therapy at least 1 year after laser conization.
authors.affiliation: Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Penna
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fambrini
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Fallani
authors.forename: Annalisa
authors.initials: A
authors.lastname: Pieralli
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Scarselli
authors.forename: Mauro
authors.initials: M
authors.lastname: Marchionni
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D019092:Conization / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects*; D008875:Middle Aged; D017698:Postmenopause; D012189:Retrospective Studies; D012307:Risk Factors; D002577:Uterine Cervical Diseases / Q000209:etiology* / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*