Laparoscopic radical hysterectomy after concomitant chemoradiation in locally advanced cervical cancer: A prospective phase II study

Valerio Gallotta, Gabriella Ferrandina, Vito Chiantera, Anna Fagotti, Francesco Fanfani, Alfredo Ercoli, Francesco Legge, Barbara Costantini, Salvatore Gueli Alletti, Carolina Bottoni, Luigi Pedone Anchora, Camilla Nero, Giovanni Scambia

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To assess the feasibility of laparoscopic radical surgery in patients with locally advanced cervical cancer (LACC) who receive chemoradiation therapy (CT/RT). Design: Prospective phase II study (Canadian Task Force classification II-1). Intervention: Patients with LACC (FIGO stage IB2-III) were evaluated for accrual at the Gynecologic Oncology Unit of Catholic University, Rome/Campobasso. Neoadjuvant CT/RT included whole-pelvic irradiation (total dose, 45.0-50.4 Gy) combined with cisplatin and 5-fluorouracil. Objective response to treatment was evaluated according to Response Evaluation Criteria in Solid Tumors criteria. Laparoscopic radical hysterectomy (RH) plus pelvic and/or aortic lymphadenectomy was attempted within 6 to 8 weeks after CT/RT. The feasibility of laparoscopic RH, as well as the rate, pattern, and severity of early and late postoperative complications, were analyzed. Results: Between January 2010 and October 2013, a total of 58 patients were enrolled into the study. After CT/RT, 23 patients (39.6%) underwent type B2 RH, 31 (53.4%) underwent type C1 RH, and 4 (6.9%) underwent type C2 RH. Pelvic lymphadenectomy was performed in all cases. Laparoscopic RH was feasible in 55 of 58 cases (feasibility rate, 94.8%). No intraoperative complications were recorded. During the observation period (median, 22 months; range, 5-50 months), there were 28 complications, of which only 21.4% were grade 2 complications and 14.3% were grade 3 complications. As of January 2015, disease recurrence was documented in 4 cases (6.9%). Conclusion: Total laparoscopic radical surgery is feasible in patients with LACC receiving preoperative CT/RT, providing perioperative outcomes comparable to those registered in early-stage disease.

Original languageEnglish
Pages (from-to)877-883
Number of pages7
JournalJournal of Minimally Invasive Gynecology
Volume22
Issue number5
DOIs
Publication statusPublished - 2015

Keywords

  • Cervical cancer
  • Laparoscopy
  • Neoadiuvant chemoradiation
  • Radical hysterectomy

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Medicine(all)

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