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 of ten 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-aort ic 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 relate d to the para-aortic and pelvic node dissection. The parametrial disse ction could be carried out in all patients. Intraoperative complicatio ns related to this part of the operation included two rectal and three urinary injuries repaired with no postoperative sequelae. In the spec imens, residual parametrial infiltration was present in three out of 1 5 stage IIB-IIIB cases. The intraoperative complication rate was 13.3% and the gross postoperative complication rate was 4.4%. Postoperative ly, only one case of ureteral fistula was recorded, yielding a rate of 2% (1/45). These data are not significantly different from those repo rted in the literature for radical surgery without neoadjuvant chemoth erapy. In locally advanced cervical cancer, radical surgery after neoa djuvant chemotherapy is feasible without any undue increase in morbidi ty and mortality.