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

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  • 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)

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.

Suggested Citation

  • Chia-Hao Liu & Yu-Chieh Lee & Jeff Chien-Fu Lin & I-San Chan & Na-Rong Lee & Wen-Hsun Chang & Wei-Min Liu & Peng-Hui Wang, 2019. "Radical Hysterectomy After Neoadjuvant Chemotherapy for Locally Bulky-Size Cervical Cancer: A Retrospective Comparative Analysis between the Robotic and Abdominal Approaches," IJERPH, MDPI, vol. 16(20), pages 1-19, October.
    • Handle: RePEc:gam:jijerp:v:16:y:2019:i:20:p:3833-:d:275153
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