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

• Published in: Annals of surgical oncology Vol. 28; no. 7; pp. 3616 - 3626
• Main Authors: Ferrandina, G., Gallotta, V., Federico, A., Fanfani, F., Ercoli, A., Chiantera, V., Cosentino, F., Turco, L. C., Legge, F., Anchora, L. Pedone, Bizzarri, N., Moroni, R., Macchia, G., Valentini, V., Scambia, G.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.07.2021; Springer Nature B.V
• Subjects: Cervical cancer; Chemoradiotherapy; Chemotherapy; Gynecologic Oncology; Lymph nodes; Medicine; Medicine & Public Health; Oncology; Patients; Radiation therapy; Surgery; Surgical Oncology; Surgical outcomes; Survival
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-020-09302-y

Purpose Chemoradiation (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 Methods Data for stage IB2–IVA cervical cancer patients managed by CT/RT and RS were retrospectively analyzed. Results Beginning 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). Conclusion MI-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.