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Surgery for cervical intraepithelial neoplasia

  1. Pierre PL Martin-Hirsch1,*,
  2. Evangelos Paraskevaidis2,
  3. Andrew Bryant3,
  4. Heather O Dickinson3

Editorial Group: Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group

Published Online: 4 DEC 2013

Assessed as up-to-date: 23 NOV 2012

DOI: 10.1002/14651858.CD001318.pub3


How to Cite

Martin-Hirsch PPL, Paraskevaidis E, Bryant A, Dickinson HO. Surgery for cervical intraepithelial neoplasia. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD001318. DOI: 10.1002/14651858.CD001318.pub3.

Author Information

  1. 1

    Royal Preston Hospital, Lancashire Teaching Hospital NHS Trust, Gynaecological Oncology Unit, Preston, Lancashire, UK

  2. 2

    Ioannina University Hospital, Department of Obstetrics and Gynaecology, Ioannina, Greece

  3. 3

    Newcastle University, Institute of Health & Society, Newcastle upon Tyne, UK

*Pierre PL Martin-Hirsch, Gynaecological Oncology Unit, Royal Preston Hospital, Lancashire Teaching Hospital NHS Trust, Sharoe Green Lane, Fullwood, Preston, Lancashire, PR2 9HT, UK. martin.hirsch@me.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 4 DEC 2013

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[Figure 1]
Figure 1. Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
[Figure 2]
Figure 2. Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
[Analysis 1.1]
Analysis 1.1. Comparison 1 Single freeze cryotherapy versus double freeze cryotherapy, Outcome 1 Residual Disease within 12 months.
[Analysis 2.1]
Analysis 2.1. Comparison 2 Laser ablation versus cryotherapy, Outcome 1 Residual Disease (All Grades of CIN).
[Analysis 2.2]
Analysis 2.2. Comparison 2 Laser ablation versus cryotherapy, Outcome 2 Residual Disease (CIN1, CIN2, CIN3).
[Analysis 2.3]
Analysis 2.3. Comparison 2 Laser ablation versus cryotherapy, Outcome 3 Peri-operative Severe Pain.
[Analysis 2.4]
Analysis 2.4. Comparison 2 Laser ablation versus cryotherapy, Outcome 4 Peri-operative Severe Bleeding.
[Analysis 2.5]
Analysis 2.5. Comparison 2 Laser ablation versus cryotherapy, Outcome 5 Vaso-motor Symptoms.
[Analysis 2.6]
Analysis 2.6. Comparison 2 Laser ablation versus cryotherapy, Outcome 6 Malodorous Discharge.
[Analysis 2.7]
Analysis 2.7. Comparison 2 Laser ablation versus cryotherapy, Outcome 7 Inadequate Colposcopy at Follow-up.
[Analysis 2.8]
Analysis 2.8. Comparison 2 Laser ablation versus cryotherapy, Outcome 8 Cervical Stenosis at Follow-up.
[Analysis 3.1]
Analysis 3.1. Comparison 3 Laser conisation versus knife conisation, Outcome 1 Residual Disease (All Grades of CIN).
[Analysis 3.2]
Analysis 3.2. Comparison 3 Laser conisation versus knife conisation, Outcome 2 Primary Haemorrhage.
[Analysis 3.3]
Analysis 3.3. Comparison 3 Laser conisation versus knife conisation, Outcome 3 Secondary Haemorrhage.
[Analysis 3.4]
Analysis 3.4. Comparison 3 Laser conisation versus knife conisation, Outcome 4 Inadequate Colposcopy at Follow-up.
[Analysis 3.5]
Analysis 3.5. Comparison 3 Laser conisation versus knife conisation, Outcome 5 Cervical Stenosis at Follow-up.
[Analysis 3.6]
Analysis 3.6. Comparison 3 Laser conisation versus knife conisation, Outcome 6 Significant Thermal Artifact Prohibiting Interpretation of Resection Margin.
[Analysis 4.1]
Analysis 4.1. Comparison 4 Laser conisation versus laser ablation, Outcome 1 Residual Disease (All Grades of Disease).
[Analysis 4.2]
Analysis 4.2. Comparison 4 Laser conisation versus laser ablation, Outcome 2 Peri-operative Severe Bleeding.
[Analysis 4.3]
Analysis 4.3. Comparison 4 Laser conisation versus laser ablation, Outcome 3 Secondary Haemorrhage.
[Analysis 4.4]
Analysis 4.4. Comparison 4 Laser conisation versus laser ablation, Outcome 4 Inadequate Colposcopy at Follow-up.
[Analysis 5.1]
Analysis 5.1. Comparison 5 Laser conisation versus loop excision, Outcome 1 Residual Disease.
[Analysis 5.2]
Analysis 5.2. Comparison 5 Laser conisation versus loop excision, Outcome 2 Duration of Procedure.
[Analysis 5.3]
Analysis 5.3. Comparison 5 Laser conisation versus loop excision, Outcome 3 peri-operative severe bleeding.
[Analysis 5.4]
Analysis 5.4. Comparison 5 Laser conisation versus loop excision, Outcome 4 Peri-operative Severe Pain.
[Analysis 5.5]
Analysis 5.5. Comparison 5 Laser conisation versus loop excision, Outcome 5 Secondary Haemorrhage.
[Analysis 5.6]
Analysis 5.6. Comparison 5 Laser conisation versus loop excision, Outcome 6 Significant Thermal Artefact on Biopsy.
[Analysis 5.7]
Analysis 5.7. Comparison 5 Laser conisation versus loop excision, Outcome 7 Depth of Thermal Artifact.
[Analysis 5.8]
Analysis 5.8. Comparison 5 Laser conisation versus loop excision, Outcome 8 Inadequate Colposcopy.
[Analysis 5.9]
Analysis 5.9. Comparison 5 Laser conisation versus loop excision, Outcome 9 Cervical Stenosis.
[Analysis 5.10]
Analysis 5.10. Comparison 5 Laser conisation versus loop excision, Outcome 10 Vaginal discharge.
[Analysis 6.1]
Analysis 6.1. Comparison 6 Laser ablation versus loop excision, Outcome 1 Residual Disease.
[Analysis 6.2]
Analysis 6.2. Comparison 6 Laser ablation versus loop excision, Outcome 2 Peri-operative Severe Pain.
[Analysis 6.3]
Analysis 6.3. Comparison 6 Laser ablation versus loop excision, Outcome 3 Primary Haemorrhage.
[Analysis 6.4]
Analysis 6.4. Comparison 6 Laser ablation versus loop excision, Outcome 4 Secondary Haemorrhage.
[Analysis 7.1]
Analysis 7.1. Comparison 7 Knife conisation versus loop excision, Outcome 1 Residual Disease.
[Analysis 7.2]
Analysis 7.2. Comparison 7 Knife conisation versus loop excision, Outcome 2 Primary Haemorrhage.
[Analysis 7.3]
Analysis 7.3. Comparison 7 Knife conisation versus loop excision, Outcome 3 Inadequate Colposcopy at Follow-up.
[Analysis 7.4]
Analysis 7.4. Comparison 7 Knife conisation versus loop excision, Outcome 4 Cervical Stenosis.
[Analysis 8.1]
Analysis 8.1. Comparison 8 Radical diathermy versus LLETZ, Outcome 1 Duration of blood loss.
[Analysis 8.2]
Analysis 8.2. Comparison 8 Radical diathermy versus LLETZ, Outcome 2 Blood stained / watery discharge.
[Analysis 8.3]
Analysis 8.3. Comparison 8 Radical diathermy versus LLETZ, Outcome 3 Yellow discharge.
[Analysis 8.4]
Analysis 8.4. Comparison 8 Radical diathermy versus LLETZ, Outcome 4 White discharge.
[Analysis 8.5]
Analysis 8.5. Comparison 8 Radical diathermy versus LLETZ, Outcome 5 Upper Abdominal Pain.
[Analysis 8.6]
Analysis 8.6. Comparison 8 Radical diathermy versus LLETZ, Outcome 6 Lower Abdominal Pain.
[Analysis 8.7]
Analysis 8.7. Comparison 8 Radical diathermy versus LLETZ, Outcome 7 Deep Pelvic Pain.
[Analysis 8.8]
Analysis 8.8. Comparison 8 Radical diathermy versus LLETZ, Outcome 8 Vaginal Pain.
[Analysis 9.1]
Analysis 9.1. Comparison 9 Knife cone biopsy: haemostatic sutures versus none, Outcome 1 Primary Haemorrhage.
[Analysis 9.2]
Analysis 9.2. Comparison 9 Knife cone biopsy: haemostatic sutures versus none, Outcome 2 Secondary Haemorrhage.
[Analysis 9.3]
Analysis 9.3. Comparison 9 Knife cone biopsy: haemostatic sutures versus none, Outcome 3 Cervical Stenosis.
[Analysis 9.4]
Analysis 9.4. Comparison 9 Knife cone biopsy: haemostatic sutures versus none, Outcome 4 Inadequate Colposcopy at Follow-up.
[Analysis 9.5]
Analysis 9.5. Comparison 9 Knife cone biopsy: haemostatic sutures versus none, Outcome 5 Dysmenorrhoea.
[Analysis 10.1]
Analysis 10.1. Comparison 10 Bipolar electrocautery scissors versus monopolar energy scalpel, Outcome 1 Peri-operative bleeding.
[Analysis 10.2]
Analysis 10.2. Comparison 10 Bipolar electrocautery scissors versus monopolar energy scalpel, Outcome 2 Duration of procedure.
[Analysis 10.3]
Analysis 10.3. Comparison 10 Bipolar electrocautery scissors versus monopolar energy scalpel, Outcome 3 Primary haemorrhage.
[Analysis 11.1]
Analysis 11.1. Comparison 11 LEEP versus cryotherapy, Outcome 1 Residual disease at 6 months.
[Analysis 11.2]
Analysis 11.2. Comparison 11 LEEP versus cryotherapy, Outcome 2 Residual disease at 12 months.
[Analysis 11.3]
Analysis 11.3. Comparison 11 LEEP versus cryotherapy, Outcome 3 Primary haemorrhage.
[Analysis 11.4]
Analysis 11.4. Comparison 11 LEEP versus cryotherapy, Outcome 4 Secondary haemorrhage.
[Analysis 11.5]
Analysis 11.5. Comparison 11 LEEP versus cryotherapy, Outcome 5 Offensive discharge.
[Analysis 11.6]
Analysis 11.6. Comparison 11 LEEP versus cryotherapy, Outcome 6 Watery discharge.
[Analysis 11.7]
Analysis 11.7. Comparison 11 LEEP versus cryotherapy, Outcome 7 Peri-operative severe pain.
[Analysis 12.1]
Analysis 12.1. Comparison 12 Pure cut setting versus blend setting when performing LLETZ, Outcome 1 Residual disease at 6 months.
[Analysis 12.2]
Analysis 12.2. Comparison 12 Pure cut setting versus blend setting when performing LLETZ, Outcome 2 Depth of thermal artefact at deep stromal margin.
[Analysis 13.1]
Analysis 13.1. Comparison 13 LLETZ versus NETZ, Outcome 1 Residual disease at 36 months.
[Analysis 13.2]
Analysis 13.2. Comparison 13 LLETZ versus NETZ, Outcome 2 Peri-operative pain.
[Analysis 13.3]
Analysis 13.3. Comparison 13 LLETZ versus NETZ, Outcome 3 Peri-operative blood loss interfering with treatment.
[Analysis 13.4]
Analysis 13.4. Comparison 13 LLETZ versus NETZ, Outcome 4 Bleeding requiring vaginal pack.
[Analysis 13.5]
Analysis 13.5. Comparison 13 LLETZ versus NETZ, Outcome 5 Cervical stenosis at follow-up.
[Analysis 14.1]
Analysis 14.1. Comparison 14 Knife conisation versus NETZ, Outcome 1 Residual disease at 36 months.
[Analysis 15.1]
Analysis 15.1. Comparison 15 LLETZ versus Knife conisation, Outcome 1 Residual disease at 36 months.