Laparoscopic Versus Open Radical Hysterectomy for Stage IB2–IIB Cervical Cancer in the Setting of Neoadjuvant Chemotherapy: A Multi-institutional Cohort Study

Abstract

Despite the lack of conclusive evidence supporting this treatment modality, neoadjuvant chemotherapy (NACT) prior to radical surgery is a commonly accepted strategy to manage locally advanced cervical cancer. Radical hysterectomy in chemotherapy-treated patients can be technically challenging due to large volume of residual disease, desmoplastic reaction, and loss of normal tissue planes as a result of the cytotoxic treatment. We sought to assess whether surgical outcomes of laparoscopic radical hysterectomy (LRH) and its open counterpart are equivalent in the setting of NACT. Prospectively maintained databases of five gynecologic oncology services were searched for stage IB2-IIB cervical cancer patients undergoing surgery after NACT. LRH and open radical hysterectomy (RAH) patients were compared with respect to perioperative outcomes and mid-term survival. Adjustment for potential selection bias in surgical approach was made with propensity score (PS) matching. LRH cases (n=68) were associated with lower-stage, lower-grade tumors compared with RAH group (n=273). When patients were grouped by stage at presentation (IB2-IIA and IIB), complication rates and perioperative outcomes were equivalent between LRH and RAH groups. LRH offered less blood loss, lower transfusion rate, and shorter hospitalization. These differences remained significant after PS matching. In the PS-matched cohort, Cox proportional hazards model including tumor stage, grade, histotype, nodal status, institution, and time period of surgery showed that laparoscopic approach was not associated with impaired survival. Laparoscopic approach seems a valuable alternative to open surgery for patients with locally advanced cervical carcinoma who have received NACT.