Can laparoscopic nerve-sparing ultra-radical hysterectomy play a role in locally advanced cervical cancer? A single-center retrospective study

Abstract

Background and objectivesThe objective of this study is to investigate the outcomes of concurrent platinum-based chemoradiation therapy (CCRT), laparoscopic nerve-sparing ultra-radical hysterectomy (LNSURH), and open radical hysterectomy (ORH) on patients with locally advanced cervical carcinoma (LACC).MethodsA single-center retrospective study was conducted on LACC patients who received CCRT, ORH, or LNSURH from January 2011 to December 2019. Data on age, tumor size, overall survival (OS), disease-free survival (DFS), and early and late morbidities were collected. After 24 months of treatment, patients were asked a series of questions about their urinary, bowel, and sexual activities. Early morbidities were defined as those occurring during or within a month of treatment, whereas late morbidities and complications were defined as those occurring a month after treatment. The postoperative complications were classified with reference to the Clavien–Dindo classification (CD) system.ResultsThe Kaplan–Meier curves revealed no significant differences in OS and DFS among the three groups (P = 0.106 for DFS and P = 0.190 for OS). The rates of early complications in the CCRT group were comparable with those in the operated groups (P = 0.46). However, late complications were significantly lower in the ORH and LNSURH groups relative to those in the CCRT group. The scores of urinary and bowel functions were restored to the pretreatment state, although the sexual function scores were not satisfactory.ConclusionsThe treatments of CCRT, ORH, and LNSURH can be considered options for patients with LACC, as their OS and DFS showed no significant difference. In addition, LNSURH exhibited a lower incidence of late complications and high sexual function scores.

A comparison of concurrent chemoradiotherapy and radical surgery in patients with specific locally advanced cervical cancer (stage IB3, IIA2, IIICr): trial protocol for a randomized controlled study (C-CRAL trial)

“…National Comprehensive Cancer Network (NCCN) guidelines in 2022 suggest concurrent chemoradiotherapy (CCRT) as the preferred recommended treatment for the specific LACC patients (category 1). However, considering insufficient radiotherapy equipment and the huge difference within regions’ medical care, the deviation in imaging staging before surgery, as well as the patient’s willingness to undertake surgical resections [ 3 ], radical surgery (RS) including radical hysterectomy (RH) + pelvic lymphadenectomy (PLD) ± para-aortic lymphadenectomy (PALD) has emerged as a valid alternative in China (category 2B). RS can effectively reduce tumor burden, preserve ovarian function for young patients and achieve accurate surgical pathological staging to guide subsequent adjuvant treatment.…”