DOES SURGICAL APPROACH INFLUENCE THE OUTCOMES OF LOCALLY ADVANCED STAGE CERVICAL CANCER AFTER NEOADJUVANT CHEMOTHERAPY?
Dr. Stefano UCCELLA
Disclosure : None of the Authors declare conflicts of interest.
No funding sources supported this investigation.
9 slide(s) – English – 2011-09-11
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Objective: Neoadjuvant chemotherapy (NCT) followed by surgery is one of the therapeutic strategies available for the management of locally advanced cervical cancer. Our aim was to compare perioperative and middle-term results of patients undergoing radical hysterectomy by laparoscopy and open surgery after NCT.
Methods: Consecutive patients who had NCT followed by total laparoscopic radical hysterectomy (TLRH)+pelvic lymphadenectomy for advanced cervical cancer were prospectively enrolled. An historical cohort of patients who had NCT and open radical surgery represented the control group. The two different surgical approach were compared in terms of peri-operative outcomes and middle-term results.
Results: Fourteen women who had NCT and LRH were compared with 24 patients who underwent open surgery+NCT. Preoperative characteristics of the study groups were similar. No differences in term of radicality (length of parametrial tissue; lymph-node count) were recorded. No difference in operative time was observed (235vs.255 minutes for laparoscopy vs. open surgery; p=0.3); median blood loss was 200 and 600 mL (p=0.0001), and median hospital stay was 4.5 and 9 day (p=0.02) for LRH and open surgery, respectively. One (7.1%) conversion occurred in the laparoscopic group for the presence of intra-peritoneal disease. Overall complication rate was higher in open abdominal cohort (p=0.03). At a minimum 2-years follow-up no differences were registered in disease-free (50%vs.61.9%;p=0.68) and overall survival (85.7%vs.76.1%;p=0.64) for laparoscopy and open surgery, respectively.
Conclusions: The administration of NCT does not appear to impair the ability to perform LRH. Laparoscopy represents a valid alternative to open surgery also in cervical cancer patients receiving neoadjuvant treatment.