Fertility-sparing Treatment For Cervical Adenocarcinoma In Situ:A Meta-analysis

Background:Cervical cancer ranks first in the female reproductive system malignancy and is the fourth most popular malignancy throughout the world.With the popularization of cervical cancer screening and people's lifestyle changes,the proportion of cervical adenocarcinomas in invasive cervical cancer has risen to 25%to 30%.Invasive adenocarcinoma of the cervix in situ adenocarcinoma(ACIS)can develop within 10 to 15 years.The age of onset of ACIS is approximately 30 to 39 years old[2].Most of the patients have no birth or still have fertility requirements,but The standard surgical procedure of ACIS is hysterectomy.This type of procedure will permanently deprive women of their fertility,making it difficult for women with fertility requirements to accept.At present,more surgical methods are used in the cold-knife conization,but clinical observations have found that the incidence of obstetric complications such as premature delivery,chorioamnitis,premature rupture of membranes,etc,while the more conservative loop electrosurgical excisional procedure surgery came into being.However,the safety,efficacy and pregnancy outcomes of loop electrosurgical excisional procedure is still controversial and need to be confirmed by further studies.Objective:In this paper,meta-analysis was used to compare the efficacy of cervical cold-knife conization and loop electrosurgical excisional procedure in the treatment of cervical adenocarcinoma in situ and pregnancy outcomes.Method:Web search for Pubmed,Cochrane Library,Embase,and medline databases until December 2017.As far as possible to collect cervical in situ adenocarcinoma for cold-knife conization and loop electrosurgical excisional procedure of the relevant literature,according to the inclusion and exclusion criteria,the non-compliant literature was excluded and quality indicators from the Newcastle-Ottawa Scale(NOS)were used to assess the quality of the included literature.Revman5.3 software was used to perform a meta-analysis of the relevant literature on the treatment of cervical adenocarcinoma in situ in patients undergoing cold-knife conization and loop electrosurgical excisional procedure.The postoperative marginal positive rate,residual residual rate,residual lesions/edge Positive cases and recurrence rates were observed indicators and quantitative comprehensive assessments were conducted.Results:A total of 18 articles were included in the study,including a total of 1559 cases,including 607 cases of loop electrosurgical excisional procedure and 952 cases of cold-knife conization.The positive rate of the edge of the loop electrosurgical excisional procedure group was 44%,the residual rate of the lesion was 9%,the residual/edge of the lesion was 27%,and the recurrence rate was 7%;The positive rate of the edge of the cold-knife conization group was 29%,the residual rate of the lesion was 11%,the residual/edge of the lesion was 41%,and the recurrence rate was 6%.The analysis showed that although the positive rate of the edge of the loop electrosurgical excisional procedure group was higher than that of the cold-cold conization group,there was no significant difference between the other two groups.One of the literatures mentioned that there was no difference between the type of conization and pregnancy outcome.Considering the insufficient sample size,the literature on postoperative outcome of LEEP or CKC showed that LEEP had better pregnancy outcome than CKC.There was no obvious bias in the inverted funnel charts of each group.Conclusions:1.Loop electrosurgical excisional procedure and cold-knife conization are safe and effective surgical methods for conservative treatment of cervical in situ adenocarcinoma patients;2.There was no significant difference in residual rate and recurrence rate between Loop electrosurgical excisional procedure and cold-knife conization,and there was a better pregnancy outcome with Loop electrosurgical excisional procedure.