The role of loop electrosurgical excisional procedure in the management of adenocarcinoma in situ of the uterine cervix.
OBJECTIVE
To evaluate the occurrence of residual or recurrent disease after loop electrosurgical excisional procedure (LEEP) for adenocarcinoma in situ (AIS) of the uterine cervix.


METHODS
Records of 78 patients with a histological diagnosis of AIS of uterine cervix on LEEP who were treated and followed at our center between 1992 and 2008 were, retrospectively, reviewed.


RESULTS
Of 78 patients who underwent LEEP, 47 had negative and 31 had positive resection margins. Of the 47 patients with negative margins, 30 underwent subsequent hysterectomy and residual AIS, including 1 invasive adenocarcinoma, was present in 17% (5/30) of patients. The remaining 17 had no additional procedures. Of the 31 patients with positive margins, 29 patients underwent subsequent hysterectomy and residual AIS, including 4 invasive adenocarcinomas, was present in 48% (14/29) of patients. The remaining two had no additional procedures. After a mean follow-up time of 28 months (range, 1-74 months), no recurrences were observed among the 19 patients who did not undergo hysterectomy.


CONCLUSIONS
The incidence of residual disease in patients with negative margins after LEEP for AIS of the uterine cervix is low but not negligible. Therefore, conservative management in these patients seems to be feasible but careful surveillance is required. However, positive resection margin carries a higher risk for residual AIS or occult invasive adenocarcinoma, warranting additional LEEP or hysterectomy in these patients.
Kim
Jong-Hyeok
JH
Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Park
Jeong-Yeol
JY
Kim
Dae-Yeon
DY
Kim
Yong-Man
YM
Kim
Young-Tak
YT
Nam
Joo-Hyun
JH
D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000601:surgery; D004598:Electrosurgery / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007044:Hysterectomy; D015994:Incidence; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000601:surgery*