Perioperative Complications and Safety Evaluation of Robot-Assisted Radical Hysterectomy of Cervical Cancer After Neoadjuvant Chemotherapy

Wei-Fu Chang; Ai-Jing Luo; Yi-Feng Yuan; Yang Chen; Zi-Rui Xin; Shuai-Shuai Xu

doi:10.2147/CMAR.S243986

Perioperative Complications and Safety Evaluation of Robot-Assisted Radical Hysterectomy of Cervical Cancer After Neoadjuvant Chemotherapy

Cancer Manag Res. 2020 Jun 12:12:4483-4492. doi: 10.2147/CMAR.S243986. eCollection 2020.

Authors

Wei-Fu Chang^{1

2

3}, Ai-Jing Luo^{1

3

4}, Yi-Feng Yuan⁵, Yang Chen⁵, Zi-Rui Xin^{3

5}, Shuai-Shuai Xu¹

Affiliations

¹ Xiangya School of Public Health, Central South University, Changsha 410008, Hunan, People's Republic of China.
² The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan, People's Republic of China.
³ Key Laboratory of Medical Information Research, Central South University, Changsha 410013, Hunan, People's Republic of China.
⁴ The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, People's Republic of China.
⁵ School of Life Sciences, Central South University, Changsha 410013, Hunan, People's Republic of China.

Abstract

Purpose: To evaluate the perioperative complications of patients with cervical cancer who are treated with robot-assisted radical hysterectomy (RRH) and to further evaluate the safety of patients undergoing NACT.

Methods: A total of 805 consecutive cervical cancer patients undergoing RRH were involved in this report. Their clinical characteristics were retrieved from hospital medical records. Perioperative complications were subdivided into intraoperative and postoperative complications, which were graded according to the Clavien-Dindo classification (CDC), and the complications of grade III and above were defined as severe complications. Furthermore, the two-level logistic regression model was used to estimate the risk factors of perioperative and severe complications and to further confirm the relationship between NACT and perioperative and severe complications.

Results: The perioperative complication rate and severe complications were 45.09% and 7.83%, respectively. Poorly differentiated tumor and NACT were identified as independent risk factors for perioperative complications by multifactor analysis. Furthermore, we concentrated on the relations between NACT and complications. The risk of perioperative complications of the group with NACT (OR = 11.08, 95% CI: 5.70-21.54) was significantly higher than the group without NACT, especially in postoperative complications (OR=17.65, 95% CI: 8.63-36.08), even after adjusting confounding factors. However, there was no statistically significant difference in terms of severe complications (OR=1.68, 95% CI: 0.64-4.41) and intraoperative complications (OR=0.51, 95% CI: 0.18-1.41). Moreover, as the times of NACT increase, the impact on perioperative complications is more pronounced. A similar trend was observed in postoperative complications, while this statistical difference was still not observed in intraoperative and severe complications.

Conclusion: This result demonstrates the feasibility and safety of RRH of cervical carcinoma after NACT in generally, since it only causes mild complications, not severe complications.

Keywords: Clavien–Dindo classification; cervical carcinoma; neoadjuvant chemotherapy; perioperative complications; robot-assisted radical hysterectomy.