Objectives Evaluate survival and prognostic factors of surgery after chemoradiotherapy (CRT) for locally advanced cervical cancer (LACC).

Methods A retrospective study was performed comparing patients who had undergone surgery following primary CRT for LACC to a control group treated only with CRT.

Results 176 patients fulfilled the inclusion criteria. Residual disease (RD) was found in 48 (55,2%) patients submitted to surgery, 32 (66,7%) had adenocarcinoma (p=0,054). The main prognostic factor related to RD in a multivariate analysis was adenocarcinoma histologic type (p = 0,005, HR = 5,54 (1,69–18,12)). Patients with RD presented higher recurrence rates n = 25 (73,5%) than those with complete pathologic response n = 9 (26,5%) (p = 0,006). Surgery performed until 6 months after CRT reduced recurrences in the first 5 years of follow up (p=0,01). Among patients submitted to surgery with RD, 89,5% (n = 17/19) presented distant metastasis during follow up (p=0,03). Multivariated analysis showed RD as a predictive factor for recurrence (p=0,02, HR = 1,85 CI (1,07–3,19)). DFS and OS was not significantly different between surgery and control group (log rank test, p = 0,25 and p = 0,13, respectively). In multivariate analysis, overall survival was found to be associated with RD (p=0,001) and recurrence (p<0,001).

Conclusions Completion surgery after CRT highlights the pathologic response as a prognostic factor. It cannot be accessed with accuracy by physical exam, imaging or biopsy and is associated with recurrence and death bringing information that can be used to tailor further treatment.