TY - JOUR
T1 - Radical hysterectomy after neoadjuvant chemotherapy for locally bulky-size cervical cancer
T2 - A retrospective comparative analysis between the robotic and abdominal approaches
AU - Liu, Chia Hao
AU - Lee, Yu Chieh
AU - Lin, Jeff Chien Fu
AU - Chan, I. San
AU - Lee, Na Rong
AU - Chang, Wen Hsun
AU - Liu, Wei Min
AU - Wang, Peng Hui
N1 - Funding Information:
Funding: This research was funded by Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan (DP2-108-21121-01-A-07), and also supported by grants from the Taipei Veterans General Hospital (V108C-085) and from the Ministry of Science and Technology, Executive Yuan (MOST: 106-2314-B-075-061-MY3), Taipei, Taiwan. The authors appreciate the financial support from the Female Cancer Foundation, Taipei, Taiwan.
Publisher Copyright:
© 2019 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2019/10/2
Y1 - 2019/10/2
N2 - 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.
AB - 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.
KW - Abdominal radical hysterectomy
KW - Bulky
KW - Cervical cancer
KW - Neoadjuvant chemotherapy
KW - Outcome
KW - Robotic radical hysterectomy
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U2 - 10.3390/ijerph16203833
DO - 10.3390/ijerph16203833
M3 - Article
C2 - 31614465
AN - SCOPUS:85073479100
SN - 1661-7827
VL - 16
JO - International Journal of Environmental Research and Public Health
JF - International Journal of Environmental Research and Public Health
IS - 20
M1 - 3833
ER -