Radical Hysterectomy After Neoadjuvant Chemotherapy for Locally Bulky-Size Cervical Cancer: A Retrospective Comparative Analysis between the Robotic and Abdominal Approaches

• Published in: International journal of environmental research and public health Vol. 16; no. 20; p. 3833
• Main Authors: Liu, Chia-Hao, Lee, Yu-Chieh, Lin, Jeff Chien-Fu, Chan, I-San, Lee, Na-Rong, Chang, Wen-Hsun, Liu, Wei-Min, Wang, Peng-Hui
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 11.10.2019; MDPI
• Subjects: Abdomen; Adult; Aged; Antineoplastic Agents - therapeutic use; Body mass; Body mass index; Body size; Bone marrow; Cancer therapies; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Cervical cancer; Cervix; Chemotherapy; Cisplatin; Comparative analysis; Female; Gynecology; Hemoglobin; Histology; Hospitals; Humans; Hysterectomy; Hysterectomy - methods; Iodine; Laparoscopy; Leukocytes (granulocytic); Lymphatic system; Middle Aged; Neoadjuvant Therapy - methods; Neoplasm Staging; Patients; Pretreatment; Probability; Retrospective Studies; Robotic Surgical Procedures - methods; Robotics; Studies; Surgeons; Surgery; Survival; Taiwan; Tumors; Uterine Cervical Neoplasms - drug therapy; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; Variables; Taiwan; neoadjuvant chemotherapy; abdominal radical hysterectomy; bulky; cervical cancer; robotic radical hysterectomy; outcome
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph16203833

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 ( = 18) or NACT-A-RH ( = 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 ( = 0.003) and worse OS ( = 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.