Radical Hysterectomy After Neoadjuvant Chemotherapy for Locally Bulky-Size Cervical Cancer: A Retrospective Comparative Analysis between the Robotic and Abdominal Approaches

Abstract

Radical hysterectomy (RH) is the standard treatment for early stage cervical cancer, but the surgical approach for locally bulky-size cervical cancer (LBS-CC) is still unclear. We retrospectively compared the outcomes of women with LBS-CC treated with neoadjuvant chemotherapy (NACT) and subsequent RH between the robotic (R-RH) and abdominal approaches (A-RH). Between 2012 and 2014, 39 women with LBS-CC FIGO (International Federation of Gynecology and Obstetrics) stage IB2–IIB were treated with NACT-R-RH (n = 18) or NACT-A-RH (n = 21). Surgical parameters and prognosis were compared. Patient characteristics were not significantly different between the groups, but the NACT-R-RH group had significantly more patients with FIGO stage IIB disease, received multi-agent-based NACT, and had a lower percentage of deep stromal invasion than the NACT-A-RH group. After NACT-R-RH, surgical parameters were better, but survival outcomes, such as disease-free survival (DFS) and overall survival (OS), were significantly worse. On multivariate analysis, FIGO stage IIB contributed to worse DFS (p = 0.003) and worse OS (p = 0.012) in the NACT-A-RH group. Women with LBS-CC treated with NACT-R-RH have better perioperative outcomes but poorer survival outcomes compared with those treated with NACT-A-RH. Thus, patients with FIGO stage IIB LBS-CC disease might not be suitable for surgery after multi-agent-based NACT.

Early and Standard Urinary Catheter Removal After Gynecological Surgery for Benign Lesions: A Quasi-Experimental Study

“…Therefore, the findings of the current study cannot expand to other populations, such as surgical treatment for patients with gynecological malignancy and/or pelvic floor dysfunction-related benign diseases. However, it is well-known that patients with gynecological cancer may be managed by much complicated surgery, and patients treated with pelvic organ prolapse surgery may have a higher risk of existed or subsequent lower urinary tract symptoms (Bisch et al, 2021; Chang et al, 2019; Chang et al, 2020; Liu et al, 2019), in which all may add the uncertainty to test our hypothesis. The enrolled patients in the current study were limited to benign gynecological tumors which needed surgical excision, regardless of use or no-use of laparoscopy assistance.…”

Employment disruption among women with gynecologic cancers

“…Of the estimated 113 520 new cases of gynecologic cancer diagnosed in 2020, 11 over half were in women younger than 65 years, a group representing a major proportion of the workforce. The existing literature on employment disruption in patients with gynecologic cancer is limited to survey-based studies without control groups, [12][13][14][15] many of which were not conducted in the USA. 12 13 16 We have previously reported that approximately 22% of patients with endometrial cancer and employer-subsidized health insurance experienced employment disruption 17 ; this was a hypothesisgenerating study that did not include patients with other gynecologic malignancies, and importantly did not have a control group to compare to the cancer population.…”

Neurogenic bladder in patients with cervical cancer after treatment

“…Cervical cancer is still a global health burden worldwide, contributing to the fourth most common cancer in women in the world and a leading cause of cancer death of women in developing countries, although cervical cancer rates are dramatically decreasing overall among women in the United States, and Taiwan after an application of precancer screening strategies. [1][2][3][4][5] Despite of which cancer subtype and human papilloma virus (HPV) infection status, primary treatment with curative intent for women with cervical cancer consists of surgery (radical hysterectomy [RH] or radical trachelectomy), concurrent chemoradiation (CCRT), or a pretreatment therapy (neoadjuvant chemotherapy [NACT]) and a combination of these treatments; and in routine clinical practice, the treatment opinion is often based on the International Federation of Obstetrics and Gynecology (FIGO) cancer stage and sometimes according to the fertility consideration. 1,2,6 However, the complications of treatment either by surgery or by CCRT have persistent negative impacts on the physiological and psychological function of women.…”

“…11 One critical and important issue about the QoL and oncology safety of women with cervical cancer after the use of modified approach based on less in place of the conventional exploratory or abdominal RH, such as minimally invasive surgery (laparoscopic and robotic approach) and nerve-sparing RH is still arguable and consensus is not in agreement for all gynecological oncologists. 1,4,5,9 Although the trend in use of less invasive procedures, including simple hysterectomy and the aforementioned modified approach for the management of early-stage cervical cancer may be increased, 12 much concern is present whether the "radicality (extent) of surgery" is adequate. 12,13 Dr. Sia used the National Cancer Database to review the case of women with FIGO stage IA2 and IB1 (<2 cm) cervical cancer between 2004 and 2015 and they found although simple hyster4ectomy did not influence the 5-year survival outcome for FIGO stage IA1 cancer (95.1% for RH and 97.6% for simple hysterectomy with HR of 0.70, 95% CI 0.41-1.20), 5-year survival was significantly better in women with FIGO IB1 treated with RH compared to that with simple hysterectomy (95.3% versus 92.4% with HR 1.55, 95% CI 1.18-2.03), suggesting the parametrial resection (parametrectomy) during hysterectomy (RH) is a critical procedure as the treatment of choice for women with FIGO stage IB1 cervical cancer.…”

“…[1][2][3][4][5] Despite of which cancer subtype and human papilloma virus (HPV) infection status, primary treatment with curative intent for women with cervical cancer consists of surgery (radical hysterectomy [RH] or radical trachelectomy), concurrent chemoradiation (CCRT), or a pretreatment therapy (neoadjuvant chemotherapy [NACT]) and a combination of these treatments; and in routine clinical practice, the treatment opinion is often based on the International Federation of Obstetrics and Gynecology (FIGO) cancer stage and sometimes according to the fertility consideration. 1,2,6 However, the complications of treatment either by surgery or by CCRT have persistent negative impacts on the physiological and psychological function of women. One of complications after treatment is pelvic floor dysfunction (PFD), which is a public health issue with significantly negative effects on quality of life (QoL).…”