CO2 laser conization for cervical intraepithelial neoplasia grade II-III:: complications and efficacy

Aims. To examine per-and postoperative complication rates and efficacy of laser conization in the treatment of cervical intraepithelial neoplasia (CIN) grade II-III. Material and methods. Eligible for analyses were all women treated with their first laser conization because of CIN II-III during the time-period January 1, 1983 to December 31, 1992. The study population comprises 1081 women who were permanent residents of one Norwegian county (Sor-Trondelag). All analyses were performed in SPSS applying chi-square for trend, Mann-Whitney test, survival analyses and logistic regression. Results. In total 86 women (8.0%) were observed with one or two (4:86) complications. Bleeding was most frequent (n=66) followed by symptomatic cervical stenosis (n= 18). Most bleeding complications (74.2%) occurred one to two weeks postoperatively. Both bleeding complications and the occurrence of cervical stenosis were associated with cone height. Three emergency hysterectomies, two for bleeding and one for bladder perforation, were performed. Persistent disease was diagnosed in 1.9% (20:1053) of the women. All women with persistent disease were diagnosed among those with CIN III. Persistent disease was more than 20 times more common among women with disease-involved resection margins compared to those with free resection margins. Conclusions. Our evaluation of ten years' consistent use of conization by CO2 laser in the treatment of CIN II-III in an unselected population showed a low overall complication rate (8%) and very high efficacy (CIN II 100%, CIN III 98.1%) of the treatment.