Meta-analysis of cold-knife conization versus loop electrosurgical excision procedure for cervical intraepithelial neoplasia

OBJECTIVE: This meta-analysis aimed to compare the superiority of loop electrosurgical excision procedure (LEEP) or large loop excision of the transformation zone (LLETZ) versus cold-knife conization (CKC) in the surgical treatment of cervical intraepithelial neoplasia (CIN). METHODS: Systematic searches were performed in the MEDLINE, EMBASE, Cochrane databases, and the China National Knowledge Infrastructure Databases to identify all potential articles involving patients with CIN treated with LEEP/LLETZ or CKC published up to February 2016. Risk ratios (RRs) or weighted mean difference (MD) with a 95% confidence interval (95% CI) were calculated. RESULTS: Seven randomized controlled trials, one prospective cohort study, and twelve retrospective cohort studies were included in this meta-analysis. There were no significant differences following LEEP/LLETZ compared with CKC in recurrence rate (RR =1.75, 95% CI =0.99–3.11, P=0.06), positive margin rate (RR =1.45; 95% CI =0.85–2.49, P=0.17), residual disease rate (RR =1.15, 95% CI =0.73–1.81, P=0.48), secondary hemorrhage (RR =1.16, 95% CI =0.74–1.81; P=0.46), or cervical stenosis. Moreover, subgroup analyses based on randomized trials also revealed that no statistical significance was observed in the above outcomes. However, women treated with CKC had a significantly deeper cervical cone than those treated with LLETZ/LEEP (MD =−5.71, 95% CI =−7.45 to −3.96; P<0.001). CONCLUSION: LEEP/LLETZ is as effective as CKC with regard to recurrence rate, positive margin rate, residual disease rate, secondary hemorrhage, and cervical stenosis for the surgical treatment of CIN. Further large-scale studies are needed to confirm our findings.