Introduction Cervical shortening and its’ possible impact on obstetrical outcomes are one of the primary concerns for women who need loop electrosurgical excision procedure (LEEP). Persistent HPV infection after LEEP is a surrogate prognostic marker guiding post-treatment surveillance. This study aims to investigate the clinical impact of cervical length change after LEEP regarding HPV clearance.

Methods Patients under 40 who underwent LEEP by a single surgeon for their cervical intraepithelial neoplasia (CIN2+) from March 2019 to December 2022 were retrospectively enrolled in this study. Cervical lengths were measured pre-procedure and three months after LEEP. The operator tried not to make fragmentation of specimen. The depth of the main ectocervical specimen was measured. Cervical length change was analyzed with the depth of the specimen and HPV clearance.

Results A total of 109 women were analyzed. The median (range) of age, initial cervical length, and ectocervical specimen depth was 31 (21~39) years, 8(1~1.8)mm, and 3(1.5~5.0)cm, respectively. CLs at post-procedure three months were obtained in 89 women (81.6%). The median(range) CL change was 3 (-10~20)mm. There was no statistical correlation between CL change and ectocervical specimen depth. HPV clearance at 3 months after LEEP was more prevalent in the thicker ectocervical specimen depth group (dichotomized by the median value, 53.2% vs. 81.1%, p=0.005). In multivariate analysis adjusting clinicopathologic factors, only ectocervical specimen depth was an independent predictive factor for HPV clearance.

Conclusion/Implications Cone depth can be individualized if CL is measured preoperatively. Standardization of CL measurement in nonpregnant women should be preceded.