Minimally Invasive Approaches in Locally Advanced Cervical Cancer Patients Undergoing Radical Surgery After Chemoradioth
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ORIGINAL ARTICLE – GYNECOLOGIC ONCOLOGY
Minimally Invasive Approaches in Locally Advanced Cervical Cancer Patients Undergoing Radical Surgery After Chemoradiotherapy: A Propensity Score Analysis G. Ferrandina, MD, PhD1,2, V. Gallotta, MD1, A. Federico, MD1, F. Fanfani, MD1,2, A. Ercoli, MD3, V. Chiantera, MD4, F. Cosentino, MD5, L. C. Turco, MD6, F. Legge, MD7, L. Pedone Anchora, MD1, N. Bizzarri, MD1, R. Moroni, PhD8, G. Macchia, MD9, V. Valentini, MD, PhD10,11, and G. Scambia, MD, PhD1,2 1
Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; 2Istituto di Ginecologia e Ostetricia, Universita` Cattolica del Sacro Cuore, Rome, Italy; 3Department of Obstetrics and Gynecology, University of Messina, Messina, Italy; 4Department of Gynecologic Oncology, University of Palermo, Palermo, Italy; 5 Gynecologic Oncology, Gemelli Molise, Campobasso, Italy; 6Gynecology and Breast Care Unit, Mater Olbia Hospital, Olbia, Italy; 7Gynecologic Oncology Unit, Department Obstetrics/Gynecology ‘‘F. Miulli’’ General Regional Hospital, Acquaviva delle Fonti, Bari, Italy; 8Direzione Scientifica, Fondazione Policlinico Universitario A.Gemelli, IRCCS, Rome, Italy; 9Radiotherapy Unit, Gemelli Molise Hospital, Campobasso, Italy; 10Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC di Radioterapia, Rome, Italy; 11Istituto di Radiologia, Universita` Cattolica del Sacro Cuore, Rome, Italy
ABSTRACT Purpose. Chemoradiation (CT/RT) followed by radical surgery (RS) may play a role in locally advanced cervical cancer (LACC) patients with suboptimal response to CT/ RT or in low-income countries with limited access to radiotherapy. Our aim is to evaluate oncological and surgical outcomes of minimally invasive radical surgery (MIRS) compared with open radical surgery (O-RS). Patients and Methods. Data for stage IB2–IVA cervical cancer patients managed by CT/RT and RS were retrospectively analyzed. Results. Beginning with 686 patients, propensity score matching resulted in 462 cases (231 per group), balanced
G. Ferrandina and V. Gallotta have contributed equally to this work.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09302-y) contains supplementary material, which is available to authorized users. Ó The Author(s) 2020 First Received: 26 May 2020 Accepted: 13 October 2020 A. Federico, MD e-mail: [email protected]
for FIGO stage, lymph node status, histotype, tumor grade, and clinical response to CT/RT. The 5-year disease-free survival (DFS) was 73.7% in the O-RS patients and 73.0% in the MI-RS patients (HR 1.034, 95% CI 0.708–1.512, p = 0.861). The 5-year locoregional recurrence rate was 12.5% (O-RS) versus 15.2% (MI-RS) (HR 1.174, 95% CI 0.656–2.104, p = 0.588). The 5-year disease-specific survival (DSS) was 80.4% in O-RS patients and 85.3% in the MI-RS group (HR 0.731, 95% CI 0.438–1.220, p = 0.228). Estimated blood loss was lower in the MI-RS group (p \ 0.0
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