Loop Electrosurgical Excision Procedure and Cold Knife Conization. which is the best? A large retrospective study

Objective. This study was performed to compare Loop Electrosurgical Excision Procedure (LEEP) and Cold Knife Cone (CKC) biopsy in the treatment of Cervical Intraepithelial Neoplasia (CIN) in terms of oncological outcome, effectiveness, and safety. Materials and Methods. In this retrospective observational study with a follow-up of 24 months patients with CIN at diagnosis were enrolled between January 2016 and July 2019. The primary outcome included: persistent disease rate, recurrent disease rate and cone biopsy positive margins. As secondary end point, we evaluated surgical time, bleeding within 24 hours, infections related to the procedure and cone size. Results. Ninety-six women were enrolled: 60 in LEEP group and 36 in cold knife conization group. Women undergoing LEEP procedure had similar primary oncological outcome without any statistical difference than those undergoing CKC (persistent disease 6 (10%) vs 2 (7.6%), recurrent disease 5 (8.3%) vs 4 (11.1%), positive margins 12 (20%) vs 7 (19.4%). Secondary endpoint included post-operative bleeding within 24 hours with a significant difference between two groups (4 (6.6%) in LEEP group and 8 (22.2%) in CKC group, p = 0.026). The remaining outcome measures, surgery time (200-215 sec.), cone size (0.86-1.57 cm3) and post-operative infections, have no significant differences. Conclusions. The surgical conization techniques evaluated gave encouraging and balanced results in terms of oncological outcome, but the LEEP technique should be considered as the primary technique for the treatment of CIN due to its simplicity of execution, cost reduction and less postoperative complications.