Abstract
Radical hysterectomy (RH) is the standard treatment for early stage cervical cancer, but the surgical approach for locally bulky-size cervical cancer (LBS-CC) is still unclear. We retrospectively compared the outcomes of women with LBS-CC treated with neoadjuvant chemotherapy (NACT) and subsequent RH between the robotic (R-RH) and abdominal approaches (A-RH). Between 2012 and 2014, 39 women with LBS-CC FIGO (International Federation of Gynecology and Obstetrics) stage IB2–IIB were treated with NACT-R-RH (n = 18) or NACT-A-RH (n = 21). Surgical parameters and prognosis were compared. Patient characteristics were not significantly different between the groups, but the NACT-R-RH group had significantly more patients with FIGO stage IIB disease, received multi-agent-based NACT, and had a lower percentage of deep stromal invasion than the NACT-A-RH group. After NACT-R-RH, surgical parameters were better, but survival outcomes, such as disease-free survival (DFS) and overall survival (OS), were significantly worse. On multivariate analysis, FIGO stage IIB contributed to worse DFS (p = 0.003) and worse OS (p = 0.012) in the NACT-A-RH group. Women with LBS-CC treated with NACT-R-RH have better perioperative outcomes but poorer survival outcomes compared with those treated with NACT-A-RH. Thus, patients with FIGO stage IIB LBS-CC disease might not be suitable for surgery after multi-agent-based NACT.
Highlights
Surgical treatment for cervical cancer (CC) has been discussed intensively owing to recent advances in minimally invasive surgery (MIS)
The pathological data, including number of resected lymph nodes (LNs), LN involvement, resection margin involvement, parametrial involvement, lymphovascular space invasion (LVSI), and pathological tumor size, were not significantly different between both groups; deep stromal invasion (DSI) was found in all 18 patients in the neoadjuvant chemotherapy (NACT)-A-Radical hysterectomy (RH) group (100%) and in 9 patients in the NACT-robotic RH (R-RH) group (42.9%; p < 0.001)
Perioperative Outcomes and Follow-up Status. Intraoperative findings, such as operative time, estimated blood loss, blood transfusion rate, postoperative visual analog scale (VAS) score, and length of hospital stay (LOS) were better in the NACT-R-RH group than in the NACT-abdominal RH (A-RH) group
Summary
Surgical treatment for cervical cancer (CC) has been discussed intensively owing to recent advances in minimally invasive surgery (MIS). The technical feasibility of minimally invasive radical hysterectomy (MIS-RH) has been previously described in numerous reports [1,2,3,4,5], but there are increasing concerns regarding the oncological outcomes, especially on the basis of the results of the recent prospective randomized trial, i.e., the international laparoscopic approach to cervical cancer (LACC) trial [6,7,8,9,10]. When most MIS-RH procedures in the LACC trial were performed via conventional L-RH (84%) and contributed to poorer survival outcomes [9], one could argue that
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: International journal of environmental research and public health
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
