Introduction/Background To assess the safety and efficacy of adjuvant salvage hysterectomy in locally advanced cervical cancer following failed intracavity brachytherapy (ICBT) and in cases of residual disease following completed treatment.
Methodology A retrospective analysis of all women referred with cervical cancer between Jan 2006 and December 2022 who underwent adjuvant salvage hysterectomy due to failed ICBT or persistent disease following completed chemoradiation. The data collected and analysed included histology, stage of disease, causes for salvage hystrerectomy, node positivity, residual disease in hysterectomy specimen, margins status, morbidity and survival rates. Data analysis was performed using RStudio Team (2020).
Results Thirty seven of 1509 (2.5%) patients treated for locally advanced cervical cancer underwent salvage hysterectomy in the assessed time period. Indications for salvage hysterectomy were failed ICBT 26/37 (70.2%) and persistent disease following completed chemoradiation 11/37 (29.7%). The overall five year survival was demonstrated to be 81% and 55% in the failed ICBT and persistent disease groups respectively (P=0.015). Involvement of the surgical margins with disease was more frequently identified in those patients who had persistent disease. The rate of significant adverse events, grade three or four Clavien-Dindo classification, was low in both groups representing only 5% of early complications.
Conclusion Adjuvant salvage hysterectomy appears to be a safe treatment option to be considered in locally advanced cervical cancer. This study has demonstrated that the procedure is associated with a low risk of significant complications irrespective of indication for surgery. In this study we have demonstrated that adjuvant salvage hysterectomy is associated with comparable five year overall survival to those treated with completed chemoradiotherapy when performed in circumstances of failed ICBT. Adjuvant salvage hysterectomy does not appear to provide the same survival benefit to those patients with persistent disease following completed chemoradiotherapy.
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