Objectives To evaluate the oncological and surgical outcome of minimally invasive radical surgery (MI-RS) compared to open radical surgery (O-RS) in locally advanced cervical cancer (LACC) after preoperative chemoradiation (CT/RT).
Methods Data relative to stage IB2-IVA cervical cancer patients managed by CT/RT and RS were retrospectively analyzed.
Results Starting from 686 patients, the propensity score matching resulted in 462 cases (231 per group), balanced for FIGO stage, lymph node status, histotype, tumor grade and clinical response to CT/RT. Overall, 107 recurrences were registered with no difference in the pattern of recurrences between the two surgical approaches. The 5-year disease-free survival (DFS) was 73.7% in the O-RS patients, 73.0% in the MI-RS ones (HR 1.034, 95% CI: 0.708–1.512, p=0.861). The 5-year locoregional recurrence rate was 12.5% (O-RS) versus 15.2% (MI-RS) (HR 1.174, 95% CI: 0.656–2.104, p=0.588). Deaths of disease were 62; the 5-yr disease-specific survival (DSS) was 80.4% in O-RS patients, 85.3% in the MI-RS group (HR 0.731, 95% CI: 0.438–1.220, p=0.228).
Estimated blood loss was lower in the MI-RS group (p<0.001), as well as length of hospital stay (p<0.001). Early postoperative complications occurred in 77 (33.3%) patients in the O-RS group, 88 (38.1%) patients in the MI-RS group (p=0.331). Fifty-six (24.2%) patients experienced late postoperative complications in the O-RS group, 61 (26.4%) in the MI-RS group (p=0.668).
Conclusion MI-RS and O-RS are associated with similar rate of recurrence and death from disease in LACC patients managed by surgery after CT/RT. No difference in early and late complications were reported.
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