title: Neoadjuvant chemotherapy followed by robotic radical hysterectomy in locally advanced cervical cancer: a multi-institution study.
abstract: OBJECTIVE
  Minimally invasive surgery has been performed in locally advanced cervical cancer (LACC) without adverse effect in patient's overall prognosis and survival. The aim of this report is to evaluate the feasibility and morbidity of total robotic radical hysterectomy (TRRH) with pelvic lymphadenectomy in patients with LACC after neo-adjuvant chemotherapy (NACT).
  
  
  METHODS
  From February 2008 to April 2013 a retrospective data collection of women undergoing TRRH for cervical cancer stage FIGO IB2 to IIB, after neo-adjuvant chemotherapy, was conducted at "Regina Elena" National Cancer Institute of Rome and European Institute of Oncology of Milan. All patients deemed operable underwent TRRH with pelvic lymphadenectomy within 4 weeks from the last chemotherapy cycle.
  
  
  RESULTS
  Median operative time was 225 min (range, 105-387 min). The median blood loss was 150 mL (range, 30-700 mL). The median number of removed pelvic lymph nodes was 23 (range, 8-69). Sixteen patients had an optimal response (12 PCR, 4 pPR1) to chemotherapy, 33 patients had a pPR2 and 11 patient showed stable disease. Adjuvant therapy was administrated in 36 patients (60%). We experienced one intra-operative complication and 19 post-operative complications, but no conversions to laparotomy were necessary to manage these complications. Six patients received a blood transfusion. At the time of this report, with a median follow-up of 28.9 months, 50 patients (83%) are free from recurrence.
  
  
  CONCLUSIONS
  This experience demonstrates the feasibility of TRRH pelvic lymphadenectomy after NACT in LACC with good accuracy and safety.
authors.affiliation: Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizza
authors.affiliation: Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy. Electronic address: giacomo.corrado@alice.it.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Corrado
authors.affiliation: Department of Gynecology, Cervical Cancer Center, European Institute of Oncology, Milan, Italy.
authors.forename: Vanna
authors.initials: V
authors.lastname: Zanagnolo
authors.affiliation: Department of Gynecology, Cervical Cancer Center, European Institute of Oncology, Milan, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Tomaselli
authors.affiliation: Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cutillo
authors.affiliation: Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Mancini
authors.affiliation: Department of Gynecology, Cervical Cancer Center, European Institute of Oncology, Milan, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Maggioni
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D015251:Epirubicin / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007069:Ifosfamide / Q000008:administration & dosage; D008197:Lymph Node Excision; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D017239:Paclitaxel / Q000008:administration & dosage; D010388:Pelvis; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
chemical_list: D015251:Epirubicin; D017239:Paclitaxel; D002945:Cisplatin; D007069:Ifosfamide
keywords: Locally advanced cervical cancer; Minimally invasive surgery; Neo-adjuvant chemotherapy; Robotic radical hysterectomy