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. 2021 Jul;28(7):3616-3626.
doi: 10.1245/s10434-020-09302-y. Epub 2020 Nov 9.

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

G Ferrandina #  1   2 , V Gallotta #  1 , A Federico  3 , F Fanfani  1   2 , A Ercoli  4 , V Chiantera  5 , F Cosentino  6 , L C Turco  7 , F Legge  8 , L Pedone Anchora  1 , N Bizzarri  1 , R Moroni  9 , G Macchia  10 , V Valentini  11   12 , G Scambia  1   2
Affiliations

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

G Ferrandina et al. Ann Surg Oncol. 2021 Jul.

Abstract

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.

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Figures

Fig. 1.
Fig. 1.
Flowchart of patients
Fig. 2.
Fig. 2.
Cumulative curves for (A) disease-free survival (DFS) and (B) disease-specific survival (DSS); (C) cumulative incidence of locoregional recurrence in the PS-weighted population
See this image and copyright information in PMC

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