title: CO2 laser cylindrical excision or standard re-conization for persistent-recurrent high-grade cervical intraepithelial neoplasia (HG-CIN) in women of fertile age.
abstract: OBJECTIVE
  To investigate the therapeutic efficacy of cylindrical or cone-shaped excision performed by laser CO2 in the conservative management of persistent-recurrent high-grade cervical intraepithelial neoplasia (HG-CIN) in women of fertile age.
  
  
  METHODS
  Ninety-four premenopausal patients with persistent-recurrent HG-CIN had undergone re-conization or cylindrical excision according to the time of reappearance of the disease. The length of the procedures, intra- and postoperative complications, height of the excised specimens, final histological findings and follow-up data were retrospectively evaluated.
  
  
  RESULTS
  Fifty-five (58.5%) persistent and 39 (41.5%) recurrent cases had undergone cylindrical excision and standard re-conization respectively. All the treatments were successfully performed in an out-patient setting under local anesthesia with no differences in term of operative time, height of removed specimens, intra- and postoperative complications between the two groups. Definitive histology confirmed HG-CIN in 95.7% of the cases and FIGO Stage Ia1 cervical cancer (negative lymph vascular space involvement, LVSI) in 4.3% of the cases. The endocervical margins were involved in 3.6% of the cylindrical (persistent) and in 17.9% of the cone-shaped (recurrent) specimens (p = 0.03). The overall cure rate after a median follow-up time of 54 months (range 10-196) was 91.5%. A third excisional procedure was performed in 8 cases of persistent-recurrent HG-CIN with a disease-free subsequent follow-up of 38 months (range 6-108).
  
  
  CONCLUSIONS
  Cylindrical or conical re-excision performed by CO2 laser according to the time of reappearance of the disease seems to be a promising conservative approach for persistent-recurrent HG-CIN even though further randomised prospective studies are needed to confirm the long-term efficacy and reproductive outcomes.
authors.affiliation: Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy. maxfambrini@libero.it
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fambrini
authors.forename: Carlo
authors.initials: C
authors.lastname: Penna
authors.forename: Annalisa
authors.initials: A
authors.lastname: Pieralli
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Fallani
authors.forename: Karin L
authors.initials: KL
authors.lastname: Andersson
authors.forename: Virginia
authors.initials: V
authors.lastname: Lozza
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Scarselli
authors.forename: Mauro
authors.initials: M
authors.lastname: Marchionni
mesh_terms: D000328:Adult; D019092:Conization / Q000379:methods*; D005260:Female; D005298:Fertility; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D054020:Lasers, Gas; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000601:surgery*