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Open AccessArticle

Radical Hysterectomy After Neoadjuvant Chemotherapy for Locally Bulky-Size Cervical Cancer: A Retrospective Comparative Analysis between the Robotic and Abdominal Approaches

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Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei 112, Taiwan
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Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei 112, Taiwan
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Department of Obstetrics and Gynecology, Taipei Medical University Hospital and Taipei Medical University, Taipei 110, Taiwan
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Department of Statistics, National Taipei University, Taipei 104, Taiwan
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Department of Orthopedic Surgery, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei 116, Taiwan
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Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan
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Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan
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Department of Medical Research, China Medical University Hospital, Taichung 440, Taiwan
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The Female Cancer Foundation, Taipei 104, Taiwan
*
Authors to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(20), 3833; https://doi.org/10.3390/ijerph16203833
Received: 22 August 2019 / Revised: 25 September 2019 / Accepted: 9 October 2019 / Published: 11 October 2019
(This article belongs to the Special Issue Gynecological Cancer)
Radical hysterectomy (RH) is the standard treatment for early stage cervical cancer, but the surgical approach for locally bulky-size cervical cancer (LBS-CC) is still unclear. We retrospectively compared the outcomes of women with LBS-CC treated with neoadjuvant chemotherapy (NACT) and subsequent RH between the robotic (R-RH) and abdominal approaches (A-RH). Between 2012 and 2014, 39 women with LBS-CC FIGO (International Federation of Gynecology and Obstetrics) stage IB2–IIB were treated with NACT-R-RH (n = 18) or NACT-A-RH (n = 21). Surgical parameters and prognosis were compared. Patient characteristics were not significantly different between the groups, but the NACT-R-RH group had significantly more patients with FIGO stage IIB disease, received multi-agent-based NACT, and had a lower percentage of deep stromal invasion than the NACT-A-RH group. After NACT-R-RH, surgical parameters were better, but survival outcomes, such as disease-free survival (DFS) and overall survival (OS), were significantly worse. On multivariate analysis, FIGO stage IIB contributed to worse DFS (p = 0.003) and worse OS (p = 0.012) in the NACT-A-RH group. Women with LBS-CC treated with NACT-R-RH have better perioperative outcomes but poorer survival outcomes compared with those treated with NACT-A-RH. Thus, patients with FIGO stage IIB LBS-CC disease might not be suitable for surgery after multi-agent-based NACT. View Full-Text
Keywords: abdominal radical hysterectomy; bulky; cervical cancer; neoadjuvant chemotherapy; outcome; robotic radical hysterectomy abdominal radical hysterectomy; bulky; cervical cancer; neoadjuvant chemotherapy; outcome; robotic radical hysterectomy
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Liu, C.-H.; Lee, Y.-C.; Lin, J. .-F.; Chan, I.-S.; Lee, N.-R.; Chang, W.-H.; Liu, W.-M.; Wang, P.-H. Radical Hysterectomy After Neoadjuvant Chemotherapy for Locally Bulky-Size Cervical Cancer: A Retrospective Comparative Analysis between the Robotic and Abdominal Approaches. Int. J. Environ. Res. Public Health 2019, 16, 3833.

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