title: Completion surgery after concomitant chemoradiation in locally advanced cervical cancer: a comprehensive analysis of pattern of postoperative complications.
abstract: BACKGROUND
  We provided a comprehensive analysis of rate, pattern, and severity of early and late postoperative complications in a very large, single-institution series of locally advanced cervical cancer (LACC) patients administered CT/RT plus radical surgery (RS).
  
  
  METHODS
  A total of 362 consecutive LACC (FIGO stage IB2-IVA) patients were submitted to RS after CT/RT at the Gynecologic Oncology Unit of the Catholic University (Rome/Campobasso). At 4 weeks after CT/RT, patients were evaluated for objective response and triaged to radical hysterectomy and pelvic ± aortic lymphadenectomy. Surgical morbidity was classified according to the Chassagne's grading system.
  
  
  RESULTS
  Most cases underwent type III-IV radical hysterectomy (N = 313, 86.5 %); pelvic lymphadenectomy was performed in all patients, while 116 patients (32.1 %) were also submitted to aortic lymphadenectomy. A total of 93 patients (25.7 %) experienced any grade postoperative complications, and 60 (16.6 %) had ≥grade 2 complications; grade 3-4 complications occurred in 21 patients (5.8 %). Of all early postoperative complications (N = 100), 31 (31.0 %) were urinary, 9 (9.0 %) were gastrointestinal, and 45 (45.0 %) were vascular. Of all late complications (N = 31), 20 (64.5 %) were urinary, 7 (22.6 %) gastrointestinal, and 2 (6.4 %) were vascular. Multivariate analysis showed that not complete clinical response to treatment retained an independent, unfavorable association with risk of development of postoperative morbidity, while advanced stage, and aortic lymphadenectomy showed only a borderline value.
  
  
  CONCLUSIONS
  Failure to achieve clinical complete response to treatment and, to a lesser extent, more advanced stage, and aortic lymphadenectomy, were associated with a higher risk of developing any grade as well as ≥grade 2 complications.
authors.affiliation: Gynecologic Oncology Unit, Department of Oncology, Catholic University, Rome, Italy, gabriella.ferrandina@libero.it.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Ferrandina
authors.forename: Alfredo
authors.initials: A
authors.lastname: Ercoli
authors.forename: Anna
authors.initials: A
authors.lastname: Fagotti
authors.forename: Francesco
authors.initials: F
authors.lastname: Fanfani
authors.forename: Valerio
authors.initials: V
authors.lastname: Gallotta
authors.forename: Alessandro P
authors.initials: AP
authors.lastname: Margariti
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Salerno
authors.forename: Vito
authors.initials: V
authors.lastname: Chiantera
authors.forename: Francesco
authors.initials: F
authors.lastname: Legge
authors.forename: Gabriella
authors.initials: G
authors.lastname: Macchia
authors.forename: Alessio G
authors.initials: AG
authors.lastname: Morganti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008197:Lymph Node Excision / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
chemical_list: D002945:Cisplatin; D005472:Fluorouracil