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Original research
Tailored radical hysterectomy for locally advanced cervical cancer
  1. Noriaki Sakuragi1,2,
  2. Masanori Kaneuchi2,
  3. Tatsuya Kato3,
  4. Chisa Shimada4,
  5. Yukiharu Todo4,
  6. Kei Ihira3,
  7. Ayako Nozaki3,
  8. Takeshi Umazume3,
  9. Yosuke Konno1,
  10. Takashi Mitamura3,
  11. Noriko Kobayashi3,
  12. Gen Murakami5 and
  13. Hidemichi Watari1
  1. 1Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
  2. 2Gynecology, Otaru General Hospital, Otaru, Japan
  3. 3Obstetrics and Gynecology, Hokkaido University Hospital, Sapporo, Japan
  4. 4Gynecologic Oncology, National Hospital Organisation Hokkaido Cancer Center, Sapporo, Japan
  5. 5Anatomy II, Sapporo Medical University, Sapporo, Japan
  1. Correspondence to Professor Noriaki Sakuragi, Gynecology, Otaru General Hospital, Otaru 047-8550, Japan; nsakuragi{at}jcom.home.ne.jp

Abstract

Objective The survival and prognostic factors for locally advanced cervical cancer treated with nerve-sparing Okabayashi–Kobayashi radical hysterectomy have not been elucidated. We aimed to evaluate the oncological outcomes of those patients after radical hysterectomy with adjuvant chemotherapy.

Methods This retrospective cohort study was conducted from January 2002 to December 2011. Treatment was conducted at a single tertiary center in northern Japan. We used the Okabayashi–Kobayashi radical hysterectomy with lymphadenectomy. We applied unilateral nerve preservation for stage IIA/IIB cancer if there was a one-sided extension of the disease outside the cervix. Indication for adjuvant therapy was based on Sedlis criteria. High-risk was defined as evidence of lymph node metastasis, pathological parametrial invasion, and a positive/close surgical margin. The choice of adjuvant therapy was chemotherapy which consisted of paclitaxel and cisplatin.

Results The study included 76 early-stage IB1 (≤4 cm) and IIA1 cervical cancer and 45 locally advanced stage IB2 (>4 cm), IIA2, and IIB disease treated consecutively. The median follow-up was 106 (range: 6-203) months. There were 18 (15%) patients with recurrence, with five of 76 in the early-stage (7%) and 13 of 45 in the locally advanced disease (29%) (P<0.001). For locally advanced cervical cancer, pT classification (P<0.001), lymph node metastasis (P=0.007), and histology (P=0.05) were associated with locoregional recurrence. The five-year locoregional recurrence rate in the locally advanced disease was 20% and 5% in the early-stage disease (P=0.01). The five-year disease-free survival in the locally advanced cervical cancer was 71% and 93% in the early-stage disease (P<0.001). The overall survival in locally advanced disease depended on the adeno-type histology and lymph node metastasis.

Conclusion The tailored use of nerve-sparing Okabayashi–Kobayashi radical hysterectomy with adjuvant chemotherapy based on tumor histology and lymph node metastasis may be a possible option as a treatment of locally advanced cervical cancer in selected patients.

  • adenocarcinoma
  • cervical cancer
  • cervix uteri
  • surgical procedures, operative

https://doi.org/10.1136/ijgc-2020-001387

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    Footnotes

    • Collaborators Gen Murakami, MD, PhD., Department of Anatomy II, Sapporo Medical University.

    • Contributors Study concept: NS, MK, YT, HW. Study design: NS, MK. Data acquisition: TK, CS, AN, KI, YK, TM. Quality control of data and algorithms: NS, HW. Data analysis and interpretation: NS, MK. Statistical analysis: NS, MK, TU. Manuscript preparation: NS. Manuscript editing: NS. Manuscript review: MK, YT, NK, HW.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Deidentified participant data may be available upon request for research purposes and upon approval by the IRB of Hokkaido University.