Presentation Date
19-10-2021 12:00 AM
Description
Cold Knife Conization (CKC) and Loop Electrical Excision Procedure (LEEP) are interventions used to treat pre-malignant and malignant cervical lesions. On occasion, multiple excisional procedures may be required to treat these lesions. This study aims to identify the risk factors associated with needing a re-excisional procedure of the cervix within one year of the first excision and to investigate if re-excisional procedures within one year are at higher risk for complications. A multi-site, retrospective study of patients aged 18 years or older undergoing either CKC or LEEP from 2019-2021. Clinicopathologic and surgical factors were examined to test for risk factors associated with surgical complication and need for re-excision. The relationship between time to second excision and complication risk during second excision was also analyzed. Continuous covariates were compared between excision groups using a Wilcoxon rank-sum test while categorical covariates were compared using a Fisher exact test. Of the 188 eligible patients, 23 underwent re-excision within one year of the first procedure, totaling 211 excisional procedures. When looking for specific risk factors associated with re- excisional procedures less than one year apart, re-excision patients were significantly more likely to have a higher pathologic grade (p=.007), have HIV (p=.032), and have a longer case duration during the re-excisional procedure (p=.018). Current or former smoking was associated with higher risk of re-excision but not statistically significant (p=.056). When comparing complication rates for patients with re-excisions within one year compared to no re-excision, no significant difference in complication rates at the first excision was found (p=.409). When comparing complications at first excision compared to second incision, the odds ratio for a complication was 9.37 times higher with re-excision compared to first excision (OR 9.37 (CI 1.48-67.9), p=.007). Finally, among the 23 patients with re-excisions, the mean time between excision days was much lower for patients with a complication in the second procedure (mean 31.5 vs 70 days), though results did not meet statistical significance (p=.067). Pathologic grade, positive HIV status, and longer case duration were found to have a statistically significant association with needing a re-excisional procedure of the cervix. Repeat excisions were more likely to have a complication. Although not statistically significant, complications with re-excisions appeared to be associated with shorter time between excisions. Optimal initial excisional procedure, potentially with specialized gynecologist, for patients with high-risk histology and/or HIV is the best route to prevent a significantly more risk repeat excisional procedure. Time to second excision should be extended greater than 35 days to surgical risk.
Recommended Citation
Robichaux, K; Bise, Claire; Jernigan, Amelia; and Castellano, Tara, "Risks for complications and need for repeat excisional procedures of the uterine cervix" (2021). Medical Research Day. 10.
https://digitalscholar.lsuhsc.edu/sommrd/2021MRD/Posters/10
Included in
Risks for complications and need for repeat excisional procedures of the uterine cervix
Cold Knife Conization (CKC) and Loop Electrical Excision Procedure (LEEP) are interventions used to treat pre-malignant and malignant cervical lesions. On occasion, multiple excisional procedures may be required to treat these lesions. This study aims to identify the risk factors associated with needing a re-excisional procedure of the cervix within one year of the first excision and to investigate if re-excisional procedures within one year are at higher risk for complications. A multi-site, retrospective study of patients aged 18 years or older undergoing either CKC or LEEP from 2019-2021. Clinicopathologic and surgical factors were examined to test for risk factors associated with surgical complication and need for re-excision. The relationship between time to second excision and complication risk during second excision was also analyzed. Continuous covariates were compared between excision groups using a Wilcoxon rank-sum test while categorical covariates were compared using a Fisher exact test. Of the 188 eligible patients, 23 underwent re-excision within one year of the first procedure, totaling 211 excisional procedures. When looking for specific risk factors associated with re- excisional procedures less than one year apart, re-excision patients were significantly more likely to have a higher pathologic grade (p=.007), have HIV (p=.032), and have a longer case duration during the re-excisional procedure (p=.018). Current or former smoking was associated with higher risk of re-excision but not statistically significant (p=.056). When comparing complication rates for patients with re-excisions within one year compared to no re-excision, no significant difference in complication rates at the first excision was found (p=.409). When comparing complications at first excision compared to second incision, the odds ratio for a complication was 9.37 times higher with re-excision compared to first excision (OR 9.37 (CI 1.48-67.9), p=.007). Finally, among the 23 patients with re-excisions, the mean time between excision days was much lower for patients with a complication in the second procedure (mean 31.5 vs 70 days), though results did not meet statistical significance (p=.067). Pathologic grade, positive HIV status, and longer case duration were found to have a statistically significant association with needing a re-excisional procedure of the cervix. Repeat excisions were more likely to have a complication. Although not statistically significant, complications with re-excisions appeared to be associated with shorter time between excisions. Optimal initial excisional procedure, potentially with specialized gynecologist, for patients with high-risk histology and/or HIV is the best route to prevent a significantly more risk repeat excisional procedure. Time to second excision should be extended greater than 35 days to surgical risk.