Radical surgery after induction chemotherapy in locally advanced cervical cancer. A feasibility study

In locally advanced cervical cancer, neoadjuvant chemotherapy has been shown to be effective for treatment of both the primary lesion and of metastatic lymph nodes. However, tumor necrosis and regression are often associated with dense fibrosis, which may complicate the surgical management. Forty-five patients with stage IB bulky-IIIB squamous cell carcinoma of the cervix underwent radical hysterectomy plus para-aortic and pelvic lymphadenectomy after one to three courses of different neoadjuvant cisplatin-based chemotherapeutic regimens. Mean operating time was 240 min. One major hemorrage was the only complication related to the para-aortic and pelvic node dissection. The parametrial dissection could be carried out in all patients. Intraoperative complications related to this part of the operation included two rectal and three urinary injuries repaired with no postoperative sequelae. In the specimens, residual parametrial infiltration was present in three out of 15 stage IIB-IIIB cases. The intraoperative complication rate was 13.3% and the gross postoperative complication rate was 4.4%. Postoperatively, only one case of ureteral fistula was recorded, yielding a rate of 2% (1/45). These data are not significantly different from those reported in the literature for radical surgery without neoadjuvant chemotherapy. In locally advanced cervical cancer, radical surgery after neoadjuvant chemotherapy is feasible without any undue increase in morbidity and mortality.