Objectives: The role of additional surgery in patients responding to radiation and chemotherapy for locally advanced cervical cancer is controversial. The goal of this study was to compare disease-free survival (DFS) and overall survival (OS) of two groups of patients, with or without additional surgery.
Study design: One hundred and eleven patients with advanced cervical cancer who responded to chemoradiotherapy followed by brachytherapy were included in a retrospective, multicenter series.
Results: Of the patients who had completion surgery (Group 1), 22.4% (15/67) had recurrence compared with 36.4% (16/44) of those who did not have surgery (Group 2). The difference is statistically significant (p=0.01). The relative risk of disease progression or death was 0.41 (95% confidence interval 0.20-0.85) (p=0.01) in favor of completion surgery. After multivariate analysis, only age, pathology and initial tumor size remained significant (respectively p=0.003, p=0.001 and p=0.03). Among the locations of recurrence in Group 1, 46.7% were pelvic (7/15) compared with 56.2% in Group 2 (9/16). In Group 1, 16.4% (11/67) of the patients died of disease compared to 20.4% (9/44) in Group 2. Of these, 45.4% (5/11) in Group 1 died after pelvic recurrence as compared to 77.8% (7/9) in Group 2.
Conclusion: Completion surgery does not improve OS but may improve DFS. There is no consensus regarding completion surgery in advanced cervical cancer with a good response to the standard treatment but we think it is safer to propose it.
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