Feasibility of laparoscopic radical hysterectomy after chemoradiation therapy in persistent locally advanced cervical cancer

Abstract

[eng] To evaluate the feasibility, the surgical outcome and oncologic results of laparoscopic radical hysterectomy (RH) in patients with suspicion of central persistent locally advanced cervical cancer (LACC) after chemoradiation therapy (CRT). Observational retrospective study including data concerning five patients between November 2005 and June 2015, with LACC and suspicion of central persistent tumour less than 2 cm. After completing treatment with CRT and brachytherapy, these patients were submitted to laparoscopic RH. Median patient age was 58.2 (45-71) years. FIGO stage at initial diagnosis was IB2: one case, IIB: three cases and IIIA: one case. Median tumour volume at diagnosis was 38 (30-42) mm. Median residual cervical tumour after treatment assessed with MRI was 14 (7-20) mm. Feasibility rate was 100 %. All cases underwent type C1 RH. The median operating time was 214 (140-360) min. Only one intraoperative complication was registered (ureteral injury). Three postoperative complications were found, two of them were grade II. However, one grade IV complication was documented: a patient with a vesicovaginal fistula who died due to long-term postoperative complications (urinary sepsis) at 1 year and 5 months after surgery. Median hospital stay was 9 days (range 4-55). Histopathological study reported tumour-free specimens in four patients with complete response after CRT, and one patient had 1-mm residual tumour. Clear surgical margins were obtained in all cases. With mean follow-up of 20.8 months (range 8-58), only one death secondary to urinary sepsis was registered. Secondary recurrence after RH was not documented. In experienced hands, laparoscopic RH after CRT therapy is feasible but with increased risk of severe complications due to surgery on irradiated tissues. This kind of surgery and the laparoscopic approach could be a less mutilating surgery that we can offer to our patients; however, we must improve the selection of cases who will benefit from this procedure.