Laparoscopic Radical Hysterectomy After Concomitant Chemoradiation in Locally Advanced Cervical Cancer: A Prospective Phase II Study.
OBJECTIVE
To assess the feasibility of laparoscopic radical surgery in patients with locally advanced cervical cancer (LACC) who receive chemoradiation therapy (CT/RT).


METHODS
Prospective phase II study (Canadian Task Force classification II-1).


METHODS
Patients with LACC (FIGO stage IB2-III) were evaluated for accrual at the Gynecologic Oncology Unit of Catholic University, Rome/Campobasso. Neoadjuvant CT/RT included whole-pelvic irradiation (total dose, 45.0-50.4 Gy) combined with cisplatin and 5-fluorouracil. Objective response to treatment was evaluated according to Response Evaluation Criteria in Solid Tumors criteria. Laparoscopic radical hysterectomy (RH) plus pelvic and/or aortic lymphadenectomy was attempted within 6 to 8 weeks after CT/RT. The feasibility of laparoscopic RH, as well as the rate, pattern, and severity of early and late postoperative complications, were analyzed.


RESULTS
Between January 2010 and October 2013, a total of 58 patients were enrolled into the study. After CT/RT, 23 patients (39.6%) underwent type B2 RH, 31 (53.4%) underwent type C1 RH, and 4 (6.9%) underwent type C2 RH. Pelvic lymphadenectomy was performed in all cases. Laparoscopic RH was feasible in 55 of 58 cases (feasibility rate, 94.8%). No intraoperative complications were recorded. During the observation period (median, 22 months; range, 5-50 months), there were 28 complications, of which only 21.4% were grade 2 complications and 14.3% were grade 3 complications. As of January 2015, disease recurrence was documented in 4 cases (6.9%).


CONCLUSIONS
Total laparoscopic radical surgery is feasible in patients with LACC receiving preoperative CT/RT, providing perioperative outcomes comparable to those registered in early-stage disease.
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: gallottav@gmail.com.
Valerio
V
Gallotta
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
Gabriella
G
Ferrandina
Division of Gynecologic Oncology, Fondazione Giovanni Paolo II, Campobasso, Italy.
Vito
V
Chiantera
Division of Minimally Invasive Gynecologic Surgery, St Maria Hospital, University of Perugia, Terni, Italy.
Anna
A
Fagotti
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
Francesco
F
Fanfani
Polyclinic of Abano Terme, Padova, Italy.
Alfredo
A
Ercoli
Division of Gynecologic Oncology, Fondazione Giovanni Paolo II, Campobasso, Italy.
Francesco
F
Legge
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
Barbara
B
Costantini
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
Salvatore
S
Gueli Alletti
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
Carolina
C
Bottoni
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
Luigi Pedone
LP
Anchora
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
Camilla
C
Nero
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
Giovanni
G
Scambia
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D002945:Cisplatin / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007558:Italy; D010535:Laparoscopy; D008197:Lymph Node Excision; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011183:Postoperative Complications / Q000601:surgery; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*
D002945:Cisplatin
Cervical cancer; Laparoscopy; Neoadiuvant chemoradiation; Radical hysterectomy