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

Chia-Hao Liu, Yu-Chieh Lee, Jeff Chien-Fu Lin, I-San Chan, Na-Rong Lee, Wen-Hsun Chang, Wei-Min Liu and Peng-Hui Wang
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Chia-Hao Liu: Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, 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
I-San Chan: Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan
Na-Rong Lee: Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan
Wen-Hsun Chang: Department of Obstetrics and Gynecology, 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

IJERPH, 2019, vol. 16, issue 20, 1-19

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.

Keywords: abdominal radical hysterectomy; bulky; cervical cancer; neoadjuvant chemotherapy; outcome; robotic radical hysterectomy (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
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