Jaddioui, Y. (Yousra) (2013) De invloed van de grootte van LETZ ingrepen op recidiefkans van een CIN-laesie en op intra-operatieve en direct postoperatieve complicaties. thesis, Medicine.
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Abstract
Background: Cervical intraepithelial neoplasia (CIN) is a potential precursor of cervical cancer. The preferred location for arise of cervix neoplasia is the transformation zone. Loop Excision of the Transformation Zone (LETZ) is an excisional surgical procedure where an attempt is made to remove the transformation zone and the entire CIN lesion. Without treatment 12 to 40 percent of the women diagnosed with CIN 3 lesion will develop an invasive carcinoma. There may be a link between the size of the LETZ surgery and the recurrence rate of CIN lesions and the development of complications. Therefore, in this retrospective study we investigated the impact of the size of LETZ surgery to recurrence formation and the risk of the occurrence of intra-operative and immediate postoperative complications. Methods: This retrospective study was based on patients in the Medical Center Leeuwarden who were treated with LETZ surgery in the period between January 2006 and December 2008. Only patients with histological proven CIN lesions or abnormal cervical cytology were included in the study. The study population (n= 176) is divided into 2 groups based on the amount of tissue removed during LETZ surgery. Patients in group 1 (n = 93), had a small procedure, in which the excision specimen is stored in 1 to 3 histopathological cassettes. Patients in group 2 (n = 83) underwent a larger LETZ procedure, in which the excision specimen is stored in 4 or more cassettes. The clinical and histopathological features, the occurrence of recurrent CIN lesions and complications were recorded. In the analysis of recurrences and complications we mainly used the Fisher's Exact test and the Student's t-test. For the statistical analysis of recurrences we also used the logistic regression analysis. Results: In the entire study population the recurrence rate was 16.5% (n = 29). In Group 1 the recurrence rate of CIN lesions was 25.8% (n = 24). This was significantly higher than in group 2 where 6.0% (n = 5) recurrences occurred (P <0.001). Furthermore logistic regression analysis showed that the factors group (P = 0.018), recurrence treatment (P <0.001) and positive margins (0.010) are significant predictors for the development of a recurrent CIN lesion. In group 2 the odds of getting a recurrence was 3.6 times as small as the odds for group 1 (OR: 0.275, 95% CI: 0094-0805). The odds of developing a recurrent CIN lesion after recurrence treatment is 7.6 times greater than the odds of developing a recurrence after a first LETZ treatment (OR: 7.557, 95% CI: 2.6-21.9, P <0.001). In group 1 the complication rate was 5.4% (n=5). In group 2 also 5 (6.0%) complications occurred. On the basis of the development of complications the two groups differed not significantly (P = 0.553). Conclusion: In comparison with small LETZ interventions large LETZ interventions lead to a reduction in recurrences of CIN 2 and CIN 3 lesions. In addition, the size of the LETZ has no influence on the formation of intra-operative and immediate post-operative bleeding. Furthermore, it can be concluded that recurrence LETZ treatments lead to a higher chance of developing CIN recurrences than LETZ treatments performed at a first CIN lesion.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Spinder, Dr. T. and Afdeling gynaecologie and Medisch Centrum Leeuwarden |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:53 |
| Last Modified: | 25 Jun 2020 10:53 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1378 |
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