Is adjuvant hysterectomy an option after radio-chemotherapy for locally advanced cervical cancer? A review

Abstract

Objective. The purpose of this paper is to review the current concepts in the literature regarding the beneficial effects of adjuvant surgery after concurrent radio-chemotherapy for locally advanced cervical cancer. Method.Research of the literature was performed using PubMed databases in order to find articles relevant to the central topic. The PICOS criteria were used to filter the results. The paper was then structured according to the PRISMA guideline.Results. 50 individual papers were analyzed and sorted according to their relevance for the topic. 18 were classified as relevant. There was little agreement as to how beneficial adjuvant hysterectomy is in locally advanced cervical cancer after chemoradiotherapy. Some articles concluded that patients with a total clinical response after initial treatment might have superior progression-free survival and overall survival after surgery. 2 articles underlined the importance of accurate restaging after primary treatment. The lack of benefit for surgery in patients with bulky disease or persistent adenopathies was agreed upon in all cases. Conclusions.The decision for adjuvant hysterectomy with or without lymphadenectomy is a controversial one and has to be personalized and taken in a multidisciplinary team.

Mind the Gap Between Scientific Literature Recommendations and Effective Implementation. Is There Still a Role for Surgery in the Treatment of Locally Advanced Cervical Carcinoma?

“…In fact, answers given by the study participants reveal that a large number of patients with LACC are still referred to surgical treatment. Therapeutic guidelines (bibliographic sources) and recent systematic analyses (18) assign surgery different roles in management algorithms. These guidelines may vary somewhat in As we said, the extent of the surgery can variate from exploratory laparoscopy to radical hysterectomy, pelvic ilio-obturator lymphnode dissection, para-aortic lymph node sampling and even complex resections involving other affected organs.…”