Minimally Invasive Approaches in Locally Advanced Cervical Cancer Patients Undergoing Radical Surgery After Chemoradiotherapy: A Propensity Score Analysis

G Ferrandina,F Fanfani,A Federico,A Ercoli,V Gallotta,G Macchia,N Bizzarri,L Pedone Anchora,G Scambia,F Legge,L C Turco,R Moroni,F Cosentino,V Chiantera,V Valentini

doi:10.1245/s10434-020-09302-y

Abstract

PurposeChemoradiation (CT/RT) followed by radical surgery (RS) may play a role in locally advanced cervical cancer (LACC) patients with suboptimal response to CT/RT or in low-income countries with limited access to radiotherapy. Our aim is to evaluate oncological and surgical outcomes of minimally invasive radical surgery (MI-RS) compared with open radical surgery (O-RS).Patients and MethodsData for stage IB2–IVA cervical cancer patients managed by CT/RT and RS were retrospectively analyzed.ResultsBeginning with 686 patients, propensity score matching resulted in 462 cases (231 per group), balanced for FIGO stage, lymph node status, histotype, tumor grade, and clinical response to CT/RT. The 5-year disease-free survival (DFS) was 73.7% in the O-RS patients and 73.0% in the MI-RS patients (HR 1.034, 95% CI 0.708–1.512, p = 0.861). The 5-year locoregional recurrence rate was 12.5% (O-RS) versus 15.2% (MI-RS) (HR 1.174, 95% CI 0.656–2.104, p = 0.588). The 5-year disease-specific survival (DSS) was 80.4% in O-RS patients and 85.3% in the MI-RS group (HR 0.731, 95% CI 0.438–1.220, p = 0.228). Estimated blood loss was lower in the MI-RS group (p < 0.001), as was length of hospital stay (p < 0.001). Early postoperative complications occurred in 77 patients (33.3%) in the O-RS group versus 88 patients (38.1%) in the MI-RS group (p = 0.331). Fifty-six (24.2%) patients experienced late postoperative complications in the O-RS group, versus 61 patients (26.4%) in the MI-RS group (p = 0.668).ConclusionMI-RS and O-RS are associated with similar rates of recurrence and death in LACC patients managed by surgery after CT/RT. No difference in early or late complications was reported.

Highlights

Cervical cancer (CC) is the fourth most common malignancy in women, with [ 500,000 new diagnoses per year and a mortality rate of approximately 50%
In our phase II ROMA-2 study adopting CT/RT with concomitant boost followed by completion surgery, we achieved 50.5% pathological complete response and only 7% rate of 3-year locoregional failure.[8]
These data have been confirmed in locally advanced cervical cancer (LACC) patients managed by MI-radical surgery (RS) after neoadjuvant chemotherapy (NACT) or preoperative CT/ RT,[19,20,21,22,23,24,25,26] but few data have been reported on clinical outcomes in patients managed with CT/RT followed by minimally invasive radical surgery (MIRS) versus open radical surgery (O-RS).[27]

Summary

Introduction

Cervical cancer (CC) is the fourth most common malignancy in women, with [ 500,000 new diagnoses per year and a mortality rate of approximately 50%. LACC trial comparing MI-RS versus O-RS ECC failed to achieve the primary end-point (i.e., noninferiority of MIRS in terms of 5-year disease-free survival).[28] Since large database studies have reported an association between MI-RS and increased rates of recurrence/death in EEC.[29] Based on these unexpected results, the NCCN guidelines and the European Society of Gynaecologic Oncology Scientific Committee have recommended that laparotomy should be considered the standard surgical approach in early-stage CC

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