Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2014

01-05-2014 | Gynecologic Oncology

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

Authors: Gabriella Ferrandina, MD, Alfredo Ercoli, MD, Anna Fagotti, MD, Francesco Fanfani, MD, Valerio Gallotta, MD, Alessandro P. Margariti, MD, Maria Giovanna Salerno, MD, Vito Chiantera, MD, Francesco Legge, MD, Gabriella Macchia, MD, Alessio G. Morganti, MD, Vincenzo Valentini, MD, Giovanni Scambia, MD

Published in: Annals of Surgical Oncology | Issue 5/2014

Login to get access

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.
Literature
1.
McNeil C. New standard of care for cervical cancer sets stage for next questions. J Natl Cancer Inst. 1999;91:500–1.PubMedCrossRef
2.
Chemoradiotherapy for Cervical Cancer Meta-analysis Collaboration (CCCMAC). Reducing uncertainties about the effect of chemoradiotherapy for cervical cancer: individual patients data meta-analysis. Cochrane Database Syst Rev. 2010;CD008285.
3.
Classe JM, Rauch P, Rodier JF, Morice P, Stoeckle E, Lasry S, et al. and Groupe des Chirurgiens de Centre de Lutte Contre le Cancer, Surgery after concurrent chemoradiotherapy and brachytherapy for the treatment of advanced cervical cancer: morbidity and outcome: results of a multicenter study of the GCCLCC (Groupe des Chirurgiens de Centre de Lutte Contre le Cancer). Gynecol Oncol. 2006;102:523–9.
4.
Ferrandina G, Margariti PA, Smaniotto D, Petrillo M, Salerno MG, Fagotti A, et al. Long-term analysis of clinical outcome and complications in locally advanced cervical cancer patients administered concomitant chemoradiation followed by radical surgery. Gynecol Oncol. 2010;119:404–10.PubMedCrossRef
5.
Motton S, Houvenaeghel G, Delannes M, Querleu D, Soulé-Tholy M, Hoff J, et al. Results of surgery after concurrent chemoradiotherapy in advanced cervical cancer: comparison of extended hysterectomy and extrafascial hysterectomy. Int J Gynecol Cancer. 2010;20:268–75.PubMedCrossRef
6.
Touboul C, Uzan C, Mauguen A, Gouy S, Rey A, Pautier P, et al. Prognostic factors and morbidities after completion surgery in patients undergoing initial chemoradiation therapy for locally advanced cervical cancer. Oncologist 2010;15:405–15.PubMedCentralPubMedCrossRef
7.
Leguevaque P, Motton S, Delannes M, Querleu D, Soule-Tholy M, Tap G, et al. Completion surgery or not after concurrent chemoradiotherapy for locally advanced cervical cancer? Eur J Obstet Gynecol Rep Biol 2011;155:188–92.CrossRef
8.
Morice P, Uzan C, Zafrani Y, Delpech Y, Gouy S, Haie-Meder C. The role of surgery after chemoradiation therapy and brachytherapy for stage IB2/II cervical cancer. Gynecol Oncol. 2007;107:S122–4.PubMedCrossRef
9.
Keys HM, Bundy BN, Stehman FB, Okagaki T, Gallup DG, Burnett AF, et al. Gynecologic Oncology Group. Radiation therapy with and without extrafascial hysterectomy for bulky stage IB cervical carcinoma: a randomized trial of the Gynecologic Oncology Group. Gynecol Oncol. 2003;89:343–53.PubMedCrossRef
10.
Morice P, Rouanet P, Rey A, Romestaing P, Houvenaeghel G, Boulanger JC, et al. Results of the GYNECO 02 study, an FNCLCC Phase III trial comparing hysterectomy with no hysterectomy in patients with a (clinical and radiological) complete response after chemoradiation therapy for stage IB or II cervical cancer. Oncologist. 2012;17:64–71.PubMedCentralPubMedCrossRef
11.
Guth U, Hadwin RJ, Schotzau A, McCormack M. Clinical outcomes and patterns of severe late toxicity in the era of chemo-radiation for cervical cancer. Arch Gynecol Obstet. 2012;285:1703–11.PubMedCrossRef
12.
Gondi V, Bentzen SM, Sklenar KL, Dunn EF, Petereit DG, Tannehill SP, et al. Severe late toxicities following concomitant chemoradiotherapy compared to radiotherapy alone in cervical cancer: an inter-era analysis. Int J Radiat Oncol Biol Phys. 2012;84:973–82.PubMedCentralPubMedCrossRef
13.
Tan LT, Zahara M. Long-term survival and late toxicity after chemoradiotherapy for cervical cancer. The Addenbrooke’s experience. Clin Oncol. 2008;20:358–64.CrossRef
14.
Houvenaeghel G, Lelievre L, Rigouard AL, Buttarelli M, Jacquemier J, Viens P, et al. Residual pelvic lymph node involvement after concomitant chemoradiation for locally advanced cervical cancer. Gynecol Oncol. 2006;102:74–9.PubMedCrossRef
15.
Cellini N, Smaniotto D, Scambia G, Luzi S, Balducci M, Ferrandina G, et al. Chemoradiation with concomitant boost followed by radical surgery in locally advanced cervical cancer: a dose-escalation study. Am J Clin Oncol. 2008;31:280–4.PubMedCrossRef
16.
Macchia G, Ferrandina G, Legge F, Deodato F, Ruggieri V, Lorusso D, et al. Prolonged chemoradiation in locally advanced carcinoma of the uterine cervix: final results of a phase II study (ESTER-1). Am J Clin Oncol. 2010;33:577–82.PubMedCrossRef
17.
Macchia G, Morganti AG, Deodato F, Cilla S, Lucidi A, Massaccesi M, et al. Concomitant boost plus large-field preoperative chemoradiation in locally advanced uterine cervix carcinoma: Phase II clinical trial final results (LARA-CC-1). Gynecol Oncol. 2012;125:594–9.PubMedCrossRef
18.
Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors: European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.PubMedCrossRef
19.
Piver MS, Rutledge F, Smith JP. Five classes of extended hysterectomy for women with cervical cancer, Obstet Gynecol. 1974;44:265–72.PubMed
20.
Chassagne D, Sismondi P, Horiot JC, Sinistrero G, Bey P, Zola P, et al. A glossary for reporting complications of treatment in gynecological cancers. Radiother Oncol. 1993;26:195–202.PubMedCrossRef
21.
Cox DR. Analysis of binary data. London: Methuen. 1970.
22.
Kaplan FL, Meier P. Non parametric estimation from incomplete observations. Am J Stat Assoc. 1958;53:457–81.CrossRef
23.
Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966;50:163–70.PubMed
24.
Cox DR. Regression models and life tables. J R Stat Soc. 1972;34:197–220.
25.
Eifel PJ, Winter K, Morris M, Levenback C, Grigsby PW, Cooper J, et al., Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90-01. J Clin Oncol. 2004;22:872–80.PubMedCrossRef
26.
Ferrandina G, Lucidi A, Paglia A, Corrado G, Macchia G, Tagliaferri L, et al. Role of comorbidities in locally advanced cervical cancer patients administered preoperative chemoradiation: impact on outcome and treatment-related complications. Eur J Surg Oncol. 2012;38:238–44.PubMedCrossRef
27.
Fanfani F, Fagotti A, Gagliardi G, Gallotta V, Zannoni GF, Scambia G. Pre-hysterectomy cone biopsy is able to predict response in locally advanced cervical cancer patients submitted to neo-adjuvant chemoradiation. Eur J Surg Oncol. 2013:39:1025–9.PubMedCrossRef
28.
Ferrandina G, Legge F, Fagotti A, Fanfani F, Distefano M, Morganti A, et al. Preoperative concomitant chemoradiotherapy in locally advanced cervical cancer: safety, outcome, and prognostic measures. Gynecol Oncol. 2007;107:S127–32.PubMedCrossRef
29.
Colombo PE, Bertrand MM, Gutowski M, Mourregot A, Fabbro M, Saint-Aubert B, et al. Total laparoscopic radical hysterectomy for locally advanced cervical carcinoma (stages IIB, IIA and bulky stages IB) after concurrent chemoradiation therapy: surgical morbidity and oncological results. Gynecol Oncol. 2009;114:404–9.PubMedCrossRef
30.
Lambaudie E, Narducci F, Bannier M, Jauffret C, Pouget N, Leblanc E, et al. Role of robot-assisted laparoscopy in adjuvant surgery for locally advanced cervical cancer. Eur J Surg Oncol. 2010;36:409–13.PubMedCrossRef
Metadata
Title
Completion Surgery After Concomitant Chemoradiation in Locally Advanced Cervical Cancer: A Comprehensive Analysis of Pattern of Postoperative Complications
Authors
Gabriella Ferrandina, MD
Alfredo Ercoli, MD
Anna Fagotti, MD
Francesco Fanfani, MD
Valerio Gallotta, MD
Alessandro P. Margariti, MD
Maria Giovanna Salerno, MD
Vito Chiantera, MD
Francesco Legge, MD
Gabriella Macchia, MD
Alessio G. Morganti, MD
Vincenzo Valentini, MD
Giovanni Scambia, MD
Publication date
01-05-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 5/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3471-y

Other articles of this Issue 5/2014

Annals of Surgical Oncology 5/2014 Go to the issue

Pancreatic Tumors

Comparison of Preoperative Conference-Based Diagnosis with Histology of Cystic Tumors of the Pancreas

Reconstructive Oncology

A Systematic Review of Morbidity Associated with Autologous Breast Reconstruction Before and After Exposure to Radiotherapy: Are Current Practices Ideal?

Original Article -– Regional Cancer Therapies

Safety of Epidural Analgesia in the Perioperative Care of Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

Hepatobiliary Tumors

Serum Antibody Titers Against Hepatitis C Virus and Postoperative Intrahepatic Recurrence of Hepatocellular Carcinoma

Hepatobiliary Tumors

Extended Neoadjuvant Chemotherapy for Borderline Resectable Pancreatic Cancer Demonstrates Promising Postoperative Outcomes and Survival

Breast Oncology

Long-Term Outcome of Neoadjuvant Endocrine Therapy with Aromatase Inhibitors in Elderly Women with Hormone Receptor-Positive Breast Cancer