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Type B versus Type C Radical Hysterectomy After Neoadjuvant Chemotherapy in Locally Advanced Cervical Carcinoma: A Propensity-Matched Analysis

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to evaluate the feasibility and safety of type B radical hysterectomy (RH) in the management of patients affected by locally advanced cervical cancer with favorable prognostic factors (tumor diameter <40 mm, negative nodes, or lymphovascular space involvement) and clinical response to neoadjuvant chemotherapy (NACT).

Methods

The data of women undergoing platinum-based NACT followed by RH plus bilateral systematic pelvic lymphadenectomy were collected. Patients undergoing type B RH (Group A) were compared with those undergoing type C RH (Group B); a propensity-matched comparison (1:1) was carried out to minimize selection biases. Postoperative complications were reported and 5-year survival outcomes were assessed using the Kaplan–Meier model.

Results

Thirty-six node-negative patients undergoing type B RH (Group A) were compared with 36 propensity-matched patients undergoing type C RH (Group B). The bladder dysfunction rate was significantly lower in Group A compared with Group B (13.9 vs. 69.4 %; p < 0.0001), and no statistically significant difference in 5-year overall survival (OS) and disease-free survival (DFS) between groups was reported (OS 93.0 vs. 96.7 %, p = 0.42; DFS 88.6 and 85.5 %, p = 0.77).

Conclusions

Type B RH after NACT in well-selected patients is a safe procedure that upholds the results of type C, reducing operative time and late postoperative morbidity, without detrimental effect on survival. Further prospective trials are warranted to confirm our results on a large scale.

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References

  1. Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin. 2006;56:106–30.

    Article  PubMed  Google Scholar 

  2. Benedetti Panici P, Greggi S, Scambia G, et al. Long-term survival following neoadjuvant chemotherapy and radical surgery in locally advanced cervical cancer. Eur J Cancer. 1998;34(3):341–6.

    Article  CAS  PubMed  Google Scholar 

  3. Benedetti Panici P, Bellati F, Pastore M, et al. An update in neoadjuvant chemotherapy in cervical cancer. Gynecol Oncol. 2007;107(1):20–2.

    Article  Google Scholar 

  4. Neoadjuvant Chemotherapy for Cervical Cancer Meta-Analysis Collaboration (NACCCMA) Collaboration. Neoadjuvant chemotherapy for locally advanced cervix cancer. Cochrane Database Syst Rev. 2004;(2):CD001774.

  5. Neoadjuvant Chemotherapy for Cervical Cancer Meta-Analysis Collaboration. Neoadjuvant chemotherapy for locally advanced cervical cancer: a systematic review and meta-analysis of individual patient data from 21 randomised trials. Eur J Cancer. 2003;39(17):2470–86.

    Article  Google Scholar 

  6. Benedetti Panici P, Scambia G, Greggi S, Di Roberto PF, Baiocchi G, Mancuso S. Neoadjuvant chemotherapy and radical surgery in locally advanced cervical carcinoma: a pilot study. Obstet Gynecol. 1988;71:344–8.

    CAS  PubMed  Google Scholar 

  7. Piver S, Rutledge F, Smith JP. Five classes of extended hysterectomy. Am J Obstet Gynecol. 1974;44:265–72.

    CAS  Google Scholar 

  8. Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol. 2008;9(3):297–303.

    Article  PubMed  Google Scholar 

  9. Landoni F, Maneo A, Cormio G, Perego P, Milani R, Caruso O, et al. Class II versus class III radical hysterectomy in stage IB–IIA cervical cancer: a prospective randomized study. Gynecol Oncol. 2001;80:3–12.

    Article  CAS  PubMed  Google Scholar 

  10. Benedetti Panici P, Angioli R, Palaia I, Muzii L, Zullo MA, Manci N, et al. Tailoring the parametrectomy in stages IA1-IB1 cervical carcinoma: is it feasible and safe? Gynecol Oncol. 2005;96:792–8.

  11. Bogani G, Cromi A, Uccella S, Serati M, Casarin J, Pinelli C, et al. Laparoscopic versus open abdominal management of cervical cancer: long-term results from a propensity-matched analysis. J Minim Invasive Gynecol. 2014;21(5):857–62.

    Article  PubMed  Google Scholar 

  12. Benedetti Panici P, Manci N, Di Donato et al. Vaginectomy: a minimally invasive treatment for cervical cancer vaginal recurrence. Int J Gynecol Cancer. 2009;19(9):1625–31.

  13. Benedetti Panici P, Zullo MA, Plotti F, Manci N, Muzii L, Angioli R. Long-term bladder function in patients with locally advanced cervical carcinoma treated with neoadjuvant chemotherapy and type 3-4 radical hysterectomy. Cancer. 2004;100: 2110–7.

  14. Plotti F, Sansone M, Di Donato V, Antonelli A, Altavilla T, Angioli R, et al. Quality of life and sexual function after type C2/type III radical hysterectomy for locally advanced cervical cancer: a prospective study. J Sex Med. 2011;8:894–904.

    Article  PubMed  Google Scholar 

  15. Benedetti Panici P, Maneschi F, D’Andrea G, et al. Early cervical carcinoma: the natural history of lymph node involvement redefined on the basis of thorough parametrectomy and giant section study. Cancer. 2000;88(10):2267–74.

  16. Martinelli F, Bogani G, Ditto A, et al. How often parametrial involvement leads to post-operative adjuvant treatment in locally advanced cervical cancer after neoadjuvant chemotherapy and type C radical hysterectomy? Eur J Surg Oncol. 2015;41(8):1089–96.

    Article  CAS  PubMed  Google Scholar 

  17. Landoni F, Sartori E, Maggino T, et al. Is there a role for postoperative treatment in patients with stage Ib2–IIb cervical cancer treated with neo-adjuvant chemotherapy and radical surgery? An Italian multicenter retrospective study. Gynecol Oncol. 2014;132:611–7.

    Article  CAS  PubMed  Google Scholar 

  18. Papadia A, Bellati F, Bogani G, Ditto A, Martinelli F, Lorusso D, et al. When does neoadjuvant chemotherapy really avoid radiotherapy? Clinical predictors of adjuvant radiotherapy in cervical cancer. Ann Surg Oncol. 2015.

  19. Cibula D, Abu-Rustum NR, Benedetti-Panici P, Köhler C, Raspagliesi F, Querleu D, et al. New classification system of radical hysterectomy: emphasis on a three-dimensional anatomic template for parametrial resection. Gynecol Oncol. 2011;122(2):264–8.

    Article  CAS  PubMed  Google Scholar 

  20. Barnes W, Waggoner S, Delgado G, Maher K, Potkul R, Barter J, et al. Manometric characterization of rectal dysfunction following radical hysterectomy. Gynecol Oncol. 1991;42:116–9.

    Article  CAS  PubMed  Google Scholar 

  21. Zullo MA, Manci N, Angioli R, Muzii L, Benedetti Panici P. Vescical dysfunctions after radical hysterectomy for cervical cancer: a critical review. Crit Rev Oncol Hematol. 2003;48(3):287–93.

    Article  PubMed  Google Scholar 

  22. Plotti F, Nelaj E, Sansone M, et al. Sexual function after modified radical hysterectomy (Piver II/type B) vs. classic radical hysterectomy (Piver III/type C2) for early stage cervical cancer. A prospective study. J Sex Med 2012;9(3):909–17.

    Article  PubMed  Google Scholar 

  23. Di Donato V, Bellati F, Fischetti M, Plotti F, Perniola G, Panici PB. Vaginal cancer. Crit Rev Oncol Hematol. 2012;81(3):286–95

    Article  PubMed  Google Scholar 

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    Authors and Affiliations

    1. Department of Gynecology, Obstetrics and Urology, Umberto I, ‘‘Sapienza’’ University of Rome, Rome, Italy

      Pierluigi Benedetti Panici MD, Violante Di Donato MD, PhD, Innocenza Palaia MD, PhD, Virginia Sibilla Visentin MD, Claudia Marchetti MD, Giorgia Perniola MD, Angela Musella MD, Maria Luisa Gasparri MD, Francesca Lecce MD, Ilaria Sabatucci MD, Marco Monti MD & Ludovico Muzii MD

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    1. Pierluigi Benedetti Panici MD
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    2. Violante Di Donato MD, PhD
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    3. Innocenza Palaia MD, PhD
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    4. Virginia Sibilla Visentin MD
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    5. Claudia Marchetti MD
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    6. Giorgia Perniola MD
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    12. Ludovico Muzii MD
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    Corresponding author

    Correspondence to Violante Di Donato MD, PhD.

    Additional information

    Pierluigi Benedetti Panici and Violante Di Donato have contributed equally to this article.

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    Panici, P.B., Di Donato, V., Palaia, I. et al. Type B versus Type C Radical Hysterectomy After Neoadjuvant Chemotherapy in Locally Advanced Cervical Carcinoma: A Propensity-Matched Analysis. Ann Surg Oncol 23, 2176–2182 (2016). https://doi.org/10.1245/s10434-015-4996-z

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    • DOI: https://doi.org/10.1245/s10434-015-4996-z

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