Clinical Significance of Surgical Margin from Loop Electrosurgical Excision Procedure

ABSTRACT

Abstract Clinical Significance of Surgical Margin from Loop Electrosurgical Excision Procedure Chantawat       Sheanakul              MD* Sumonmal       Manusirivithaya    MD* Siriwan             Tangjetgamol        MD* Nantana           Kaewpila                 MD** Sura                  Chomxhalaem       MD* *Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital **Department of Pathology, Srinakharinwirot University Objective: To determine the prevalence and the correlated factors of unfree surgical margin from LEEP (loop electrosurgical excision Procedure) together with the relationship between surgical margin and residual disease. Study design: Retrospective descriptive study. Subiects One hundred and six women who underwent LEEP and were diagnosed as cervical intraepithelial neoplasia to microinvasive cervical cancer at BMA Medical College and Vajira Hospital between June 1, 1996 and May 31, 2001. Methods: Medical records and follow up information of the target population were retrospectively reviewed concerning the personal history, surgical margin from LEEP, pathological reports from LEEP and hysterectomy specimens. Main outcome measures: Prevalence of unfree surgical margin from LEEP, residual disease from hysterectomy specimens. Results: During the period of study, unfree surgical margin was found in 43 cases (40.6%). Unfree surgical margin was found in 71.4% of microinvasine, 38.2% and 25.0% in patients with HSIL (high grade squamous intraepithelial lesion) and LSIL (low grade squamous intraepithelial lesion) respectively. From 58 cases who underwent hysterectomy, residual disease was found in 40.6% of unfree surgical margin which was significantly higher than 11.5% in those with free surgical margin (p=0.014). Conclusion: The prevalence of unfree surgical margin from LEEP in this study was 40.6%. Severity of disease was the significant prognostic factor for unfree surgical margin and this positive margin was significantly correlated with the higher incidence of residual disease. Key words surgical margin, residual disease, LEEP Vajira Med J 2002 ; 46 179 - 186