title: Long-term outcomes of a loop electrosurgical excision procedure for cervical intraepithelial neoplasia in a high incidence country.
abstract: OBJECTIVE
  To evaluate the operative, oncologic and obstetric outcomes of the loop electrosurgical excision procedure (LEEP) in cases with cervical neoplasia.
  
  
  METHODS
  A retrospective cohort study was conducted on patients who were suspected of cervical neoplasia and therefore undergoing LEEP at Siriraj Hospital, Mahidol University, Thailand, during 1995-2000. Outcome measures included operative complications in 407 LEEP patients and long-term outcomes in the 248 patients with cervical intraepithelial neoplasia (CIN) who were treated with only LEEP.
  
  
  RESULTS
  There were 407 patients undergoing LEEP; their mean age was 39.7±10.5 years. The histopathology of LEEP specimens revealed that 89 patients (21.9%) had lesions ≤CIN I, 295 patients (72.5%) had CIN II or III, and 23 patients (5.6%) had invasive lesions. Operative complications were found in 15 patients and included bleeding (n=9), and infection (n=7). After diagnostic LEEP, 133 patients underwent hysterectomy as the definite treatment for cervical neoplasia. Of 248 CIN patients who had LEEP only, seven (2.8%) had suffered recurrence after a median of 16 (range 6-93) months; one had CIN I, one had CIN II, and five had CIN III. All of these recurrent patients achieved remission on surgical treatment with re-LEEP (n=6) or simple hysterectomy (n=1). A significant factor affecting recurrent disease was the LEEP margin involved with the lesion (p=0.05). Kaplan-Meier analysis showed 5-year and 10-year disease-free survival (DFS) estimates of 99.9%. Twelve patients became pregnant a total of 14 times, resulting in 12 term deliveries and two miscarriages - one of which was due to an incompetent cervix.
  
  
  CONCLUSIONS
  LEEP for patients with cervical neoplasia delivers favorable surgical, oncologic and obstetric outcomes.
authors.affiliation: Gynecologic Oncology Division, 2Gynecologic Cytology Unit, 3Gynecologic Endocrinology Unit, 4Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand E-mail : irene_siriraj@yahoo.com.
authors.forename: Suthi
authors.initials: S
authors.lastname: Sangkarat
authors.forename: Irene
authors.initials: I
authors.lastname: Ruengkhachorn
authors.forename: Mongkol
authors.initials: M
authors.lastname: Benjapibal
authors.forename: Somsak
authors.initials: S
authors.lastname: Laiwejpithaya
authors.forename: Weerasak
authors.initials: W
authors.lastname: Wongthiraporn
authors.forename: Manee
authors.initials: M
authors.lastname: Rattanachaiyanont
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003127:Colposcopy; D004598:Electrosurgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013785:Thailand; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000401:mortality / Q000473:pathology / Q000601:surgery*