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



A prospective (preplanned) study of a nonrandomized controlled trial (Canadian Task Force classification level 2).



Catholic University of the Sacred Hearth, Rome, Italy.



Between September 2013 and January 2016, a total of 40 patients with LACC (Fédération Internationale de Gynécologie et d'Obstétrique stage IB2-III) were enrolled in the study.



Robotic radical hysterectomy (RRH) plus pelvic and/or aortic lymphadenectomy was attempted within 6 weeks after CT/RT. The feasibility of TRRS as well as the rate, pattern, and severity of early and late postoperative complications were analyzed.



After CT/RT, 29 patients (72.5%) underwent type B2 RRH, and 11 (27.5%) underwent type C1 RRH. Pelvic lymphadenectomy was performed in all cases. TRRS was successful in 39 of 40 cases (feasibility rate = 97.5%). In patients successfully completing TRRS, the median operating time was 185 minutes (range, 100-330 minutes), and the median blood loss was 100 mL (range, 50-300 mL). The median time of hospitalization counted from the first postoperative day was 2 days (range, 1-4 days). No intraoperative complications were recorded. During the observation period (median = 18 months; range, 4-28 months), 9 of 40 (22.5%) experienced postoperative complications, for a total number of 12 complications. As of April 2016, recurrence of disease was documented in 5 cases (12.5%).



TRRS is feasible in LACC patients administered preoperative CT/RT, providing perioperative outcomes comparable with those registered in early-stage disease, and LACC patients receiving neoadjuvant chemotherapy.
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: gallottav@gmail.com.
Valerio
V
Gallotta
Department of Obstetrics and Gynecology, University Hospital "Paolo Giaccone", Palermo, Italy.
Vito
V
Chiantera
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
Carmine
C
Conte
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
Giuseppe
G
Vizzielli
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
Anna
A
Fagotti
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.
Barbara
B
Costantini
Department of Obstetrics and Gynecology, University Hospital "Paolo Giaccone", Palermo, Italy.
Alessandro
A
Lucidi
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
Carla
C
Cicero
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
Giovanni
G
Scambia
Department of Medicine and Health Sciences, University of Molise/Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy.
Gabriella
G
Ferrandina
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D003131:Combined Modality Therapy; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008197:Lymph Node Excision / Q000009:adverse effects; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*
Chemoradiation; Locally advanced cervical cancer; Robotic radical hysterectomy