Abstract
The role of surgery in early-stage cervical cancer has been established, but it is controversial in locally advanced cervical cancer. To determine whether a radical hysterectomy method with extended removal of paracervical tissue for locally advanced cervical cancer is associated with satisfactory oncological outcomes. This retrospective cohort study was conducted from January 1, 2002, to December 31, 2011, and participants were patients with cervical cancer at a single tertiary center in Northern Japan. The median follow-up period was 106 months, and none of the patients were lost to follow-up at less than 60 months. Data analyses were performed from July 1, 2017, to December 31, 2018. Patients underwent radical hysterectomy using the Okabayashi-Kobayashi method. Bilateral nerve preservation was used for stage IB1/IB2 disease and unilateral nerve preservation for stage IIA/IIB if disease extension outside the uterine cervix was 1-sided. Chemotherapy was used as the choice of adjuvant treatment for patients with an intermediate or high risk of recurrence, while some patients chose or were assigned to radiotherapy. Primary outcomes were the 5-year local control rate and 5-year overall survival rate along with risk factor analysis. Of 121 consecutive patients, 76 (62.8%) had early-stage cervical cancer in 2008 International Federation of Gynecology and Obstetrics stages IB1 and IIA1 and 45 (37.2%) had locally advanced cervical cancer in stages IB2, IIA2, and IIB. The median (range) age was 42 (26-68) years. Adjuvant radiotherapy was used in 2 patients (3%) with early-stage cervical cancer and 3 (7%) of those with locally advanced cervical cancer. The 5-year local control rates for early-stage cervical cancer and locally advanced cervical cancer were 99% and 87%, respectively. The 5-year overall survival rates for early-stage cervical cancer and locally advanced cervical cancer were 95% and 82%, respectively. Cox regression analysis showed that lymph node metastasis and histology of adeno(squamous)carcinoma were independent risk factors for the overall survival of patients with cervical cancer treated with radical hysterectomy. The nerve-sparing Okabayashi-Kobayashi radical hysterectomy for locally advanced cervical cancer may provide survival not inferior to radical hysterectomy or radiotherapy in published literature. The applicability of radical hysterectomy with adjuvant chemotherapy for locally advanced cervical cancer needs to be validated by prospective comparative trials.
Highlights
Cervical cancer is the fourth most common type of malignant neoplasm in women.[1]
Adjuvant radiotherapy was used in 2 patients (3%) with early-stage cervical cancer and 3 (7%) of those with locally advanced cervical cancer
Cox regression analysis showed that lymph node metastasis and histology of adeno(squamous)carcinoma were independent risk factors for the overall survival of patients with cervical cancer treated with radical hysterectomy
Summary
Cervical cancer is the fourth most common type of malignant neoplasm in women.[1]. The peak incidence of cervical cancer occurs in the age group of the 30s to 40s in many countries.[2,3,4,5] Surgery has advantages over radiotherapy because the long-term intractable complications of radiation therapy can be avoided, and ovarian and sexual function in younger patients can be maintained.[6,7] Radical hysterectomy has been evolving over 100 years since the first description of extended abdominal hysterectomy by Wertheim in 1912.8 The Wertheim operation was modified later worldwide.[9,10,11] The Meigs operation is commonly used in Western countries, and the Okabayashi operation is used in Japan and some areas of Asian countries. The Kobayashi method preserves the pelvic splanchnic nerves and the inferior hypogastric plexus (modified Okabayashi radical hysterectomy).[12,13] The systematic nerve-sparing procedure opens the tissue plane between the parametrium/paracolpium and the pelvic nerve structures.[14,15,16,17]
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