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Long-Term Outcomes After Cervical Cold Knife Conization or Loop Electrosurgical Excision Procedure.

Huan Yi1,2,3, Yishan Liu2, Xuan Yin4

  • 1Department of Gynecology Oncology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou City, Fujian Province, China.

JAMA Surgery
|June 3, 2026
PubMed
Summary
This summary is machine-generated.

Cold knife conization (CKC) reduces cervical lesion recurrence and improves human papillomavirus (HPV) clearance compared to loop electrosurgical excision (LEEP). This study highlights CKC as a potentially more effective treatment for cervical intraepithelial neoplasia.

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Area of Science:

  • Gynecology
  • Oncology
  • Public Health

Background:

  • Cervical intraepithelial neoplasia (CIN) and carcinoma in situ are treated with cold knife conization (CKC) or loop electrosurgical excision (LEEP).
  • Long-term effectiveness of CKC versus LEEP for HPV clearance and preventing lesion recurrence is not well-established.

Purpose of the Study:

  • To compare the long-term incidence of human papillomavirus (HPV) clearance and cervical lesion recurrence following CKC versus LEEP.

Main Methods:

  • A cohort study utilized nationwide (Sweden) and hospital-based (China) data from 1997-2022.
  • Target trial emulation with inverse probability of censoring weighting balanced covariates.
  • Weighted Cox models assessed recurrence risk (HRs, 95% CIs) and HPV clearance rates.

Main Results:

  • Cold knife conization (CKC) showed a significantly lower risk of recurrence (HR 0.67 in Sweden, 0.41 in China) compared to loop electrosurgical excision (LEEP).
  • CKC demonstrated higher HPV clearance rates at 3, 6, and 12 months in the Chinese cohort.
  • Recurrence rates were 21.2% for both procedures in Sweden and 1.8% for LEEP vs. 0.8% for CKC in China.

Conclusions:

  • Cold knife conization (CKC) is associated with reduced cervical lesion recurrence and enhanced HPV clearance compared to loop electrosurgical excision (LEEP).
  • Findings suggest CKC may be a more effective treatment for CIN and carcinoma in situ.