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Completion Surgery After Concomitant Chemoradiation in Locally Advanced Cervical Cancer: A Comprehensive Analysis of Pattern of Postoperative Complications

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

Abstract

Background

We provided a comprehensive analysis of rate, pattern, and severity of early and late postoperative complications in a very large, single-institution series of locally advanced cervical cancer (LACC) patients administered CT/RT plus radical surgery (RS).

Methods

A total of 362 consecutive LACC (FIGO stage IB2-IVA) patients were submitted to RS after CT/RT at the Gynecologic Oncology Unit of the Catholic University (Rome/Campobasso). At 4 weeks after CT/RT, patients were evaluated for objective response and triaged to radical hysterectomy and pelvic ± aortic lymphadenectomy. Surgical morbidity was classified according to the Chassagne’s grading system.

Results

Most cases underwent type III–IV radical hysterectomy (N = 313, 86.5 %); pelvic lymphadenectomy was performed in all patients, while 116 patients (32.1 %) were also submitted to aortic lymphadenectomy. A total of 93 patients (25.7 %) experienced any grade postoperative complications, and 60 (16.6 %) had ≥grade 2 complications; grade 3–4 complications occurred in 21 patients (5.8 %). Of all early postoperative complications (N = 100), 31 (31.0 %) were urinary, 9 (9.0 %) were gastrointestinal, and 45 (45.0 %) were vascular. Of all late complications (N = 31), 20 (64.5 %) were urinary, 7 (22.6 %) gastrointestinal, and 2 (6.4 %) were vascular. Multivariate analysis showed that not complete clinical response to treatment retained an independent, unfavorable association with risk of development of postoperative morbidity, while advanced stage, and aortic lymphadenectomy showed only a borderline value.

Conclusions

Failure to achieve clinical complete response to treatment and, to a lesser extent, more advanced stage, and aortic lymphadenectomy, were associated with a higher risk of developing any grade as well as ≥grade 2 complications.

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Disclosure

The Authors declare they have no conflict of interest to disclose.

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Authors and Affiliations

  1. Gynecologic Oncology Unit, Department of Oncology, Catholic University, Rome, Italy

    Gabriella Ferrandina MD, Valerio Gallotta MD, Alessandro P. Margariti MD & Giovanni Scambia MD

  2. Gynecologic Oncology Unit, Policlinico Abano Terme, Padua, Italy

    Alfredo Ercoli MD

  3. Gynecologic Surgery, University of Perugia, Terni, Italy

    Anna Fagotti MD

  4. Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy

    Francesco Fanfani MD

  5. Obstetrics/Gynecology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy

    Maria Giovanna Salerno MD

  6. Gynecologic Oncology Unit, Department of Oncology, “Giovanni Paolo II” Foundation, Campobasso, Italy

    Vito Chiantera MD & Francesco Legge MD

  7. Division of Radiotherapy, Department of Oncology, “Giovanni Paolo II” Foundation, Campobasso, Italy

    Gabriella Macchia MD & Alessio G. Morganti MD

  8. Division of Radiotherapy, Catholic University, Rome, Italy

    Vincenzo Valentini MD

Authors
  1. Gabriella Ferrandina MD
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  2. Alfredo Ercoli MD
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  3. Anna Fagotti MD
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  4. Francesco Fanfani MD
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  5. Valerio Gallotta MD
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  6. Alessandro P. Margariti MD
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  7. Maria Giovanna Salerno MD
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  8. Vito Chiantera MD
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  9. Francesco Legge MD
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  10. Gabriella Macchia MD
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  11. Alessio G. Morganti MD
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  12. Vincenzo Valentini MD
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  13. Giovanni Scambia MD
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Correspondence to Gabriella Ferrandina MD.

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Ferrandina, G., Ercoli, A., Fagotti, A. et al. Completion Surgery After Concomitant Chemoradiation in Locally Advanced Cervical Cancer: A Comprehensive Analysis of Pattern of Postoperative Complications. Ann Surg Oncol 21, 1692–1699 (2014). https://doi.org/10.1245/s10434-013-3471-y

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  • DOI: https://doi.org/10.1245/s10434-013-3471-y

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