Evaluating the necessity of endocone resection during LLETZ: Impact of routine ECC and follow-up testing in...

The risk of cervical dysplastic changes, re-surgery, and abnormal Pap smear for patients after LLETZ due to high-grade squamous intraepithelial lesions is highest within patients with endocervical positive (surgical resection) margins of precancerous lesions and with cells of HSIL in the endocervical curettage in their primary LLETZ. This research aimed to determine whether performing endocone resection during LLETZ procedure with routine ECC reduces the risk of recurrent/persistent cervical dysplastic changes and to assess the significance of the Pap smear and high-risk human papillomavirus test in follow-up care. A retrospective analysis of 404 patients at the University of Wuerzburg was conducted. The risk of recurrent dysplastic changes was similar between patients with or without endocone resection when HSIL was present in the ECC (OR 19.66 vs OR 19.11). Abnormal Pap smears occurred in 21.4% patients without endocone resection and 27.3% with resection, both showing HSIL in the ECC. Regardless of endocone status, 50% patients with HSIL in the ECC required further surgery. HR-HPV positivity after surgery is correlated with higher rates of re-surgery (SR = 1.3) and recurrent dysplastic changes (SR = 4.0). This study indicates that performing an endocone resection is redundant, as ECC results sufficiently predict clinical outcomes.