Comparative Analysis Of Different Surgical Approaches After Neoadjuvant Chemotherapy In The Treatment Of Locally Advanced Cervical Cancer

Locally advanced cervical cancer(LACC) is a group of gynecologic malignancies with poor prognosis and easy to relapse as the main characteristics. There are different treatment regimens in different medical institutions, the different surgical approaches reflect their own advantages and disadvantages in the treatment.Reasonable treatment plan is the guarantee of good clinical efficacy.Objective:To comparatively analyze the surgical and oncological results of four surgical approaches including abdominal radical hysterectomy(ARH), laparoscopic radical hysterectomy(LRH), robotic radical hysterectomy(RRH) and laparoscopically assisted vaginal radical hysterectomy(LVRH) for locally advanced cervical cancer(LACC). The patiants underwent neoadjuvant chemotherapy(NACT) before surgery. To provide the reference about reasonable choice of surgical approach.Methods:A retrospective review of 223 patiens with LACC of the PLA General Hospital during January 2010 and July 2015 is performed. Depending on the surgical approach these patients are divided into ARH group, LRH group, RRH group and LVRH group. Summarize the intraoperative and postoperative data, pathological findings, relapse metastasis,overall survival rate(OS) and disease-free survival rate (DFS).Results:The 223 patients included FIGO stage IB2 of 63, IIA2 of 70, IIB of 90, squamous cell carcinoma in 206, adenocarcinoma in 11, adenosquamous carcinoma in 2, neuroendocrine cell carcinoma and small cell carcinoma in 4. The four group patiants’surgical age, body mass index, tumor diameter, catheter removal time, complications, mortality, pathology, adjuvant treatment, complications, postoperative metastasis was no significant statistical difference, p> 0.05, but the blood loss, operative time, number of lymph node resection, recurrence rate, transfusion rate was statistically difference, p<0.05. ARH group’ blood loss (866.8 ± 519ml) was significantly more than the other three groups; RRH group’ operation time(51.4 ± 67.7 min) was the longest and LVRH group’ operative time(181.6 ± 60.8min) was the shortest. The lymph nodes resected of LVRH group were 17.3 ± 7 pieces, which was the least among the four groups. ARH group’ transfusion rate(75.8%) was significantly higher than the other three groups. Recurrence rate respectively was:6.6% in ARH group,16.4% in LRH group,7.8% in RRH group,26.9% in group, p<0.05, LVRH group’recurrence rate was the highest.There was no significant difference among the other three groups, p> 0.05. After an average follow-up of 28 ± 17.6 months, the four groups’ 3-year overall survival rate(OS) and disease-free survival rate (DFS) was no statistically significant difference. Respectively the 3-OS was 87.7% in ARH group,83.3% in LRH group,88.6% in RRH group,63.2% in LVRH group, P> 0.05, the 3-DFS was 87.5% in ARH group,78.8% in LRH group,92.7% in RRH group,72.7% in LVRH group, P> 0.05.Conclusion:Surgical treatment is safe for the patiants with LACC who are sensitive to NACT. LRH or RRH is the best surgical approach because of the similar oncological results with ARH and LVRH, The first two without increasing the complication and recurrence rate can reach the purpose of minimally invasive including the less bleeding, the faster recovery.