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  • Results of Surgery After Concurrent Chemoradiotherapy in Advanced Cervical Cancer: Comparison of Extended Hysterectomy and Extrafascial Hysterectomy

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Cervical Cancer
Results of Surgery After Concurrent Chemoradiotherapy in Advanced Cervical Cancer: Comparison of Extended Hysterectomy and Extrafascial Hysterectomy
  1. Stéphanie Motton, MD*,
  2. Gilles Houvenaeghel, PhD†,
  3. Martine Delannes, MD‡,
  4. Denis Querleu, PhD‡,
  5. Marc SoulÉ-Tholy, MD*,
  6. Jean Hoff, PhD* and
  7. Pierre Lèguevaque, MD*
  1. *Service de Chirurgie Générale et Gynécologique, Centre Hospitalier et Universitaire Rangueil, Toulouse;
  2. †Service de Chirurgie Oncologique, Centre de Lutte contre le Cancer, Institut Paoli-Calmettes, Marseille; and
  3. ‡Service de Radiotherapie, Centre de Lutte contre le Cancer, Institut Claudius Regaud, Toulouse, France.
  1. Address correspondence and reprint requests to Stéphanie Motton, MD, Service de Chirurgie Générale et Gynécologique, CHU Rangueil, avenue Jean Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France. E-mail: mottonsteph{at}yahoo.fr.

Abstract

Objectives: The primary objective of this study was to compare disease-free survival (DFS) and overall survival (OS) of patients with and without completion surgery. The secondary objective was to compare DFS and OS of patients who had had systematic simple extrafascial hysterectomy or extended hysterectomy. The other objectives were to compare early and late complications with and without completion surgery and between the various surgical techniques.

Methods: One hundred seventy-one patients with advanced cervical cancer were included in a retrospective, multicenter series.

Results: The rate of pelvic control was 81.29% in our study after chemoradiotherapy, but histological residual cervical tumor persisted in nearly half of cases (49.71%). After a mean follow-up of 33 months, OS and DFS were not significantly higher in surgically treated patients, nor was the complication rate higher. Overall survival and DFS were not better after radical hysterectomy than after extrafascial hysterectomy. Statistically significant predictors of survival were clinical stage, tumor size, node extension, and residual tumor after chemoradiotherapy.

Conclusion: There is no consensus regarding the maximal residual tumor volume after chemoradiotherapy suitable for surgery as there is no reliable imaging yet. Therefore, extrafascial hysterectomy with bilateral pelvic lymphadenectomy seems as a reasonable option if there are histological factors suggesting poor prognosis.

  • Surgery
  • Chemoradiotherapy
  • Cervical cancer
  • Radical hysterectomy
  • Extrafascial hysterectomy

https://doi.org/10.1111/IGC.0b013e3181c9e385

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    Footnotes

    • No funding was requested for this publication.

    • No relevant financial, personal, political, intellectual, or religious interest needs to be disclosed.

    • All authors contributed in the clinical part of the study. P.L. has contributed in the conception of the protocol and statistical analysis. S.M. has contributed in the conception of the protocol and writing the manuscript.

    • No ethical approval was requested as this type of procedure is well recognized in clinical practice.