1
|
Zeng S, Xiao S, Xu Y, Yang P, Hu C, Jin X, Liu L. Efficacy and safety analysis of non-radical surgery for early-stage cervical cancer (IA2 ~ IB1): a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1337752. [PMID: 38745744 PMCID: PMC11091289 DOI: 10.3389/fmed.2024.1337752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Objective Radical hysterectomy has long been considered as the standard surgical treatment for early-stage cervical cancer (IA2 to IB1 stages), according to the 2009 International Federation of Obstetrics and Gynecology. This study aims to conduct an in-depth evaluation of the effectiveness and safety of non-radical surgery as an alternative treatment for patients with early-stage cervical cancer. Methods A systematic search of online databases including PubMed, Embase, and the Cochrane Library was conducted to identify relevant literature on surgical treatment options for early-stage cervical cancer. Keywords such as "cervical cancer," "conservative surgery," "early-stage," "less radical surgery," and "simple hysterectomy" were used. Meta-analysis was performed using Stata 15.0 software, which included randomized controlled trials (RCTs) and cohort studies. Results This meta-analysis included 8 eligible articles covering 9 studies, with 3,950 patients in the simple hysterectomy (SH) surgery group and 6,271 patients in the radical hysterectomy (RH) surgery group. The results indicate that there was no significant difference between the two groups in terms of the Overall Survival (OS) (HR = 1.04, 95% CI: 0.86-1.27, p = 0.671; Heterogeneity: I2 = 33.8%, p = 0.170), Disease Free Survival (DFS) (HR = 1.39, 95% CI: 0.59-3.29, p = 0.456; Heterogeneity: I2 = 0.0%, p = 0.374), Cervical Cancer Specific Survival (CCSS) (HR = 1.11, 95% CI: 0.80-1.54, p = 0.519; Heterogeneity: I2 = 11.9%, p = 0.287) and recurrence rate (RR = 1.16, 95% CI: 0.69-1.97, p = 0.583; Heterogeneity: I = 0.0%, p = 0.488). However, the mortality rate (RR = 1.35, 95% CI: 1.10-1.67, p = 0.006; Heterogeneity: I2 = 35.4%, p = 0.158) and the rate of postoperative adjuvant therapy (RR = 1.59, 95% CI: 1.16-2.19, p = 0.004; Heterogeneity: I2 = 92.7%, p < 0.10) were higher in the SH group compared to those in the RH group. On the other hand, the incidence of surgical complications was lower in the SH group (RR = 0.36, 95% CI: 0.21-0.59, p = 0.004; Heterogeneity: I2 = 0.0%, p = 0.857) than that in the RH group. Subgroup analysis revealed that patients in the IB1 stage SH group had a significantly higher mortality rate compared to those in the RH group (RR = 1.59, 95% CI: 1.23-2.07, p < 0.001; Heterogeneity: I2 = 0.0%, p = 0.332). However, there was no significant difference in mortality rates between the two groups for patients at stage IA2 (RR = 0.84, 95% CI: 0.54-1.30, p = 0.428; Heterogeneity: I2 = 26.8%, p = 0.243). In the subgroups positive for Lymphovascular Space Invasion (LVSI), patients in the SH group had a significantly higher mortality rate than those in the RH group (RR = 1.34, 95% CI: 1.09-1.65, p = 0.005; Heterogeneity: I2 = 41.6%, p = 0.128). However, in the LVSI-negative subgroups, there was no significant difference in mortality rates between the two groups (RR = 0.33, 95% CI: 0.01-8.04, p = 0.499). Conclusion For patients with early-stage cervical cancer patients at IA2 without LVSI involvement, comparisons between the two groups in terms of OS, DFS, CCSS, recurrence rate, and mortality rates revealed no statistically significant differences, indicating that the choice of surgical approach does not affect long-term survival outcomes for this specific patient group. For patients at IB1 and IA2 stages with LVSI involvement, while there were no significant differences between the two groups in OS, DFS, CSS, and recurrence rate, a significant increase in mortality rates was observed in the SH group. This indicates a potential elevated risk of mortality associated with SH in this subset of patients. Notably, the incidence of surgical complications was significantly lower in the SH group compared to the RH group, highlighting the safety profile of SH in this context. Significantly, among patients in the SH group, an increase in the rate of postoperative adjuvant treatment is associated with a higher occurrence of treatment-related complications. To facilitate more precise patient selection for conservative surgical management, future prospective studies of superior quality are imperative to gain deeper insights into this matter. Systematic review registration PROSPERO (CRD42023451609: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023451609).
Collapse
Affiliation(s)
- Siyuan Zeng
- Department of Obstetrics and Gynecology, Dalian Municipal Central Hospital, Dalian, China
- Dalian Municipal Central Hospital, China Medical University, Shenyang, China
| | - Simin Xiao
- Radiology Department, XinDu Hospital of Traditional Chinese Medicine, Chengdu, China
| | - Yang Xu
- Department of Obstetrics and Gynecology, Dalian Municipal Central Hospital, Dalian, China
- Dalian Municipal Central Hospital, China Medical University, Shenyang, China
| | - Ping Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chenming Hu
- Department of Obstetrics and Gynecology, Dalian Municipal Central Hospital, Dalian, China
| | - Xianyu Jin
- Dalian Municipal Central Hospital, China Medical University, Shenyang, China
| | - Lifeng Liu
- Department of Obstetrics and Gynecology, Dalian Municipal Central Hospital, Dalian, China
- Dalian Municipal Central Hospital, China Medical University, Shenyang, China
| |
Collapse
|
2
|
Viveros-Carreño D, Pareja R, Plante M. De-escalation of surgical radicality for non-fertility preserving management in patients with early-stage cervical cancer: a systematic review. Int J Gynecol Cancer 2024; 34:386-392. [PMID: 38438182 DOI: 10.1136/ijgc-2023-004593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVE We sought to evaluate the oncologic outcomes of simple hysterectomy in patients with low-risk early-stage cervical cancer (tumors ≤2 cm with limited stromal invasion). METHODS This study was registered in PROSPERO (registration number CRD42023433840) following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) checklist. MEDLINE (through Ovid), EmMBASEbase, and Cochrane Central Register of Controlled Trials were searched from inception until June 2023. Randomized controlled trials and observational studies with two arms of comparison (simple hysterectomy with lymph node assessment vs radical hysterectomy with lymph node assessment) in patients with low-risk early-stage cervical cancer were considered. RESULTS The search identified 1270 articles; eighteen studies were considered potentially eligible after removing duplicates, and four met the selection criteria. Three studies were randomized controlled trials, and the other was a retrospective cohort study. In total, 981 patients were included. There were 485 (49.4%) and 496 (50.6%) patients in the simple hysterectomy and radical hysterectomy groups, respectively. Simple hysterectomy with lymph node assessment was not associated with a higher risk of death at 5 years (RR 0.98, 95% CI: 0.31 to 3.10; I2=0%, two randomized controlled trials, 141 patients, for an absolute risk reduction of zero percentage points [95% CI -9.0 to 9.0]), pelvic recurrence at 3 years (97.5% and 97.8% for simple hysterectomy and radical hysterectomy, respectively, p=0.79), and overall recurrence at 3 years (95 %% and 100% for simple hysterectomy and radical hysterectomy, respectively, p=0.30). CONCLUSION Simple hysterectomy with lymph node evaluation for low-risk early-stage cervical cancer is not associated with a detrimental effect on oncologic outcomes and has a better morbidity profile.
Collapse
Affiliation(s)
- David Viveros-Carreño
- Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia
- Gynecologic Oncology, Clínica Universitaria Colombia And Clínica Los Nogales, Bogotá, Colombia
| | - Rene Pareja
- Gynecologic Oncology, Clinica ASTORGA, Medellin, and Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Marie Plante
- Obstetrics and Gynecology, Centre Hospitalier Universitaire de Quebec, Quebec, Quebec, Canada
| |
Collapse
|
3
|
Bianchi T, Grassi T, Bazzurini L, Di Martino G, Negri S, Fruscio R, Trezzi G, Landoni F. Radical Hysterectomy in Early-Stage Cervical Cancer: Abandoning the One-Fits-All Concept. J Pers Med 2023; 13:1292. [PMID: 37763060 PMCID: PMC10532817 DOI: 10.3390/jpm13091292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Two pillars in modern oncology are treatment personalization and the reduction in treatment-related morbidity. For decades, the one-fits-all concept of radical hysterectomy has been the cornerstone of early-stage cervical cancer surgical treatment. However, no agreement exists about the prevalent method of parametrial invasion, and the literature is conflicting regarding the extent of parametrectomy needed to achieve adequate surgical radicality. Therefore, authors started investigating if less radical surgery was feasible and oncologically safe in these patients. Two historical randomized controlled trials (RCTs) compared classical radical hysterectomy (RH) to modified RH and simple hysterectomy. Less radical surgery showed a drastic reduction in morbidity without jeopardizing oncological outcomes. However, given the high frequency of adjuvant radiotherapy, the real impact of reduced radicality could not be estimated. Subsequently, several retrospective studies investigated the chance of tailoring parametrectomy according to the tumor's characteristics. Parametrial involvement was shown to be negligible in early-stage low-risk cervical cancer. An observational prospective study and a phase II exploratory RCT have recently confirmed the feasibility and safety of simple hysterectomy in this subgroup of patients. The preliminary results of a large prospective RCT comparing simple vs. radical surgery for early-stage low-risk cervical cancer show strong probability of giving a final answer on this topic.
Collapse
Affiliation(s)
- Tommaso Bianchi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy; (T.B.); (S.N.); (R.F.); (F.L.)
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, 20900 Monza, Italy; (L.B.); (G.D.M.); (G.T.)
| | - Tommaso Grassi
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, 20900 Monza, Italy; (L.B.); (G.D.M.); (G.T.)
| | - Luca Bazzurini
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, 20900 Monza, Italy; (L.B.); (G.D.M.); (G.T.)
| | - Giampaolo Di Martino
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, 20900 Monza, Italy; (L.B.); (G.D.M.); (G.T.)
| | - Serena Negri
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy; (T.B.); (S.N.); (R.F.); (F.L.)
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, 20900 Monza, Italy; (L.B.); (G.D.M.); (G.T.)
| | - Robert Fruscio
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy; (T.B.); (S.N.); (R.F.); (F.L.)
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, 20900 Monza, Italy; (L.B.); (G.D.M.); (G.T.)
| | - Gaetano Trezzi
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, 20900 Monza, Italy; (L.B.); (G.D.M.); (G.T.)
| | - Fabio Landoni
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy; (T.B.); (S.N.); (R.F.); (F.L.)
- Clinic of Obstetrics and Gynecology, IRCCS Fondazione San Gerardo dei Tintori, 20900 Monza, Italy; (L.B.); (G.D.M.); (G.T.)
| |
Collapse
|
4
|
Ekdahl L, Crusensvärd M, Reynisson P, Lönnerfors C, Persson J. Quality of life and long-term clinical outcome following robot-assisted radical trachelectomy. Eur J Obstet Gynecol Reprod Biol 2021; 267:234-240. [PMID: 34837852 DOI: 10.1016/j.ejogrb.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/31/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
Abstract
Quality of Life and long-term clinical outcome following robot-assisted radical trachelectomy. OBJECTIVES To evaluate quality of life (QoL) and long-term clinical outcome following robot-assisted radical trachelectomy (RRT). STUDY DESIGN Prospectively retrieved clinical data were rereviewed on all women planned for a fertility sparing RRT for early stage cervical cancer at Skåne University Hospital, Sweden between 2007 and 2020. QoL was assessed using the validated questionnaires EORTC QLQ-C30, QLQ-CX24 and the Swedish LYMQOL. RESULTS Data was analyzed from 49 women, 42 with a finalised RRT and seven with an aborted RRT due to nodal metastases (n = 3) or insufficient margins (n = 4). At a median follow-up time of 54 months one recurrence (2%) occurred (aborted RRT). According to QLQ-C30 the median global health status score was 75. The disease specific QLQ-C24 showed an impact on symptoms related to sexual function where sexual/vaginal functioning had a median score of 25 and 48% of patients reported worry that sex would cause physical pain. Despite this the functional items sexual activity and sexual enjoyment both had a median score of 66.7. Lymphoedema was reported in 45%, where 9% reported severe symptom with an impact on their QoL. No intraoperative complications and no postoperative complications ≥ Clavien Dindo grade III were observed. Twenty-two of 28 (79%) women who attempted to conceive were successful. A metronidazole/no intercourse regimen was applied between GW 15 + 0-21 + 6 in 26 of 28 pregnancies beyond first trimester resulting in a 92% term (≥GW 36 + 0) delivery rate. CONCLUSIONS Although robot-assisted radical trachelectomy in this cohort was associated with a low recurrence rate, a high fertility rate and an exceptionally high term delivery rate, women's quality of life was affected postoperatively, particularly with regards to their sexual well-being and lymphatic side-effects.
Collapse
Affiliation(s)
- Linnea Ekdahl
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden
| | - Malin Crusensvärd
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden
| | - Petur Reynisson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden
| | - Celine Lönnerfors
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden
| | - Jan Persson
- Department of Obstetrics and Gynaecology, Division of Gynaecologic Oncology, Skåne University Hospital, Lund, Sweden; Lund University Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology, 22185 Lund, Sweden.
| |
Collapse
|
5
|
Muallem MZ. A New Anatomic and Staging-Oriented Classification of Radical Hysterectomy. Cancers (Basel) 2021; 13:cancers13133326. [PMID: 34283057 PMCID: PMC8267649 DOI: 10.3390/cancers13133326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 12/02/2022] Open
Abstract
Simple Summary The main deficits of the available classifications of radical hysterectomy are the facts that they are based only on the lateral extension of resection, do not depend on the precise anatomy of parametrium and paracolpium and do not correlate with the tumour stage, size or infiltration in the vagina. This new suggested classification depends on the 3-dimentional concept of parametrium and paracolpium and the comprehensive description of the anatomy of parametrium, paracolpium and the pelvic autonomic nerve system. Each type in this classification tailored to the tumour stage according to FIGO- classification from 2018, taking into account the tumour size, localization and infiltration in the vaginal vault, which may make it the most suitable tool for planning and tailoring the surgery of radical hysterectomy. Abstract The current understanding of radical hysterectomy more is centered on the uterus and little is being discussed about the resection of the vaginal cuff and the paracolpium as an essential part of this procedure. This is because that the current classifications of radical hysterectomy are based only on the lateral extent of resection. This way is easier to be understood but does not reflect the anatomical and surgical conception of radical hysterectomy and the three-dimensional ways of tumour spreading, neither meet the need of adjusting the radicality according to the different stages of FIGO classification, which depends—at least in the early stages—on the tumour volume and the infiltration in the vagina (but not on the directly spread in the parametrium). The new classification presented in this paper does not base anymore on the lateral extent of resection only but too on the depth of resection in the small pelvic and the extent of the resected vaginal vault without or with its three-dimensional paracolpium. This classification takes into account the tumour size, stage, localization and infiltration in the vaginal vault and may offer the optimal tool to adjust and tailor the surgery according to these important variables.
Collapse
Affiliation(s)
- Mustafa Zelal Muallem
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany
| |
Collapse
|
6
|
Yang FC, Huang W, Yang W, Liu J, Ai G, Luo N, Guo J, Chua PT, Cheng Z. Cervical Cancer Surgery: Current State of Affairs. Gynecol Minim Invasive Ther 2021; 10:75-83. [PMID: 34040965 PMCID: PMC8140537 DOI: 10.4103/gmit.gmit_81_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/21/2020] [Accepted: 01/18/2021] [Indexed: 11/04/2022] Open
Abstract
Cervical cancer surgery has a history of more than 100-years whereby it has transitioned from the open approach to minimally invasive surgery (MIS). From the era of clinical exploration and practice, minimally invasive gynecologic surgeons have never ceased to explore new frontiers in the field of gynecologic surgery. MIS has fewer postoperative complications, including reduction of treatment-related morbidity and length of hospital stay than laparotomy; this forms the mainstay of treatment for early-stage cervical cancer. However, in November 2018, the New England Journal of Medicine had published two clinical studies on cervical cancer surgery (Laparoscopic Approach to Cervical Cancer [LACC]). Following these publications, laparoscopic surgery for early-stage cervical cancer has come under intense scrutiny and negative perceptions. Many studies began to explore the concept of standardized surgery for early-stage cervical cancer. In this article, we performed a review of the history of cervical cancer surgery, outlined the standardization of cervical cancer surgery, and analyzed the current state of affairs revolving around cervical cancer surgery in the post-LACC era.
Collapse
Affiliation(s)
- Fan Chun Yang
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Wei Huang
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Weihong Yang
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Jie Liu
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Guihai Ai
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Ning Luo
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Jing Guo
- Gynecological Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, China
| | | | - Zhongping Cheng
- Department of Obstetrics and Gynecology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.,Gynecological Minimally Invasive Surgery Research Center, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
7
|
Kasius JC, van der Velden J, Denswil NP, Tromp JM, Mom CH. Neo-adjuvant chemotherapy in fertility-sparing cervical cancer treatment. Best Pract Res Clin Obstet Gynaecol 2021; 75:82-100. [PMID: 33752979 DOI: 10.1016/j.bpobgyn.2021.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/31/2021] [Indexed: 12/20/2022]
Abstract
The current review provides a literature overview of studies assessing the oncological and fertility outcomes of treatment with neo-adjuvant chemotherapy followed by fertility-sparing surgery in patients with cervical cancer >2 cm. Six cohort studies were included showing severe heterogeneity regarding patient selection, chemotherapy regimen, and surgical approach. In total, 111 patients were studied, with overall favorable characteristics. Patients were on average 29 years old, had a tumor of 36 mm, no lymph node metastasis, and response to chemotherapy. In approximately 5-year follow-up, the recurrence rate was 13% (0%-21%) and overall death rate 2.7% (0%-10%). Three patients were alive with recurrent disease (2.7% and 0%-11%). Of the 111 patients, 90 underwent successful fertility-sparing treatment (83%). Roughly one-third conceived and one-fourth had a healthy live-born child. More research is essential to determine proper selection criteria for fertility-sparing treatment of cervical cancer >2 cm and the optimal treatment management.
Collapse
Affiliation(s)
- Jenneke C Kasius
- Gynecologic Oncology, Amsterdam University Medical Centre, Amsterdam, Centre for Gynecologic Oncology, Amsterdam, the Netherlands.
| | - Jacobus van der Velden
- Gynecologic Oncology, Amsterdam University Medical Centre, Amsterdam, Centre for Gynecologic Oncology, Amsterdam, the Netherlands
| | | | - Jacqueline M Tromp
- Gynecologic Oncology, Amsterdam University Medical Centre, Amsterdam, Centre for Gynecologic Oncology, Amsterdam, the Netherlands
| | - Constantijne H Mom
- Gynecologic Oncology, Amsterdam University Medical Centre, Amsterdam, Centre for Gynecologic Oncology, Amsterdam, the Netherlands
| |
Collapse
|
8
|
Liu CH, Lee YC, Lin JCF, Chan IS, Lee NR, Chang WH, Liu WM, Wang PH. Radical Hysterectomy After Neoadjuvant Chemotherapy for Locally Bulky-Size Cervical Cancer: A Retrospective Comparative Analysis between the Robotic and Abdominal Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203833. [PMID: 31614465 PMCID: PMC6843229 DOI: 10.3390/ijerph16203833] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/25/2019] [Accepted: 10/09/2019] [Indexed: 12/18/2022]
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.
Collapse
Affiliation(s)
- Chia-Hao Liu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan.
| | - Yu-Chieh Lee
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital and Taipei Medical University, Taipei 110, Taiwan.
| | - Jeff Chien-Fu Lin
- Department of Statistics, National Taipei University, Taipei 104, Taiwan.
- Department of Orthopedic Surgery, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei 116, Taiwan.
| | - I-San Chan
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan.
| | - Na-Rong Lee
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan.
| | - Wen-Hsun Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan.
| | - Wei-Min Liu
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital and Taipei Medical University, Taipei 110, Taiwan.
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan.
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan.
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan.
- Department of Medical Research, China Medical University Hospital, Taichung 440, Taiwan.
- The Female Cancer Foundation, Taipei 104, Taiwan.
| |
Collapse
|