Clinical outcomes after surgical treatment for locally advanced bulky cervical cancer

Objective To observe the efficacy of surgical treatment in patients with locally advanced bulky cervical cancer (LABCC),analyze the relevant prognostic indicators,so as to provide evidence for clinical practice. Methods A retrospective comparative clinical study was conducted in 354 patients with cervical cancer (stageⅠA2-ⅡA2) who were treated in our hospital from January 2013 to January 2015.According to the FIGO2009 staging criteria,the stage ⅠB2 (n=57) and ⅡA2 (n=34) cases (lesion≥4 cm) were included in the LABCC group,while the stage ⅠA2 (n=12),ⅠB1 (n=189) and ⅡA1 (n=62) cases (lesion<4 cm) were included in the control group.General data,perioperative indicators,complications and survival analysis indicators were compared between the two groups. Results Of the 354 cases,91 patients were included in the LABCC group and 263 patients in the control group.Compared with the control group,more patients in LABCC group received neoadjuvant chemotherapy69 cases (75.8%) vs45 cases (17.1%),P<0.001,LABCC group had more intraoperative blood loss (598.1±135.3ml vs450.8±117.5ml,P<0.001) and higher blood transfusion rate (11 cases12.1%vs 14 cases5.3%,P=0.030),longer postoperative hospital stay (14.1±1.4d vs12.1±1.5d,P<0.001),and a higher incidence of urinary injury (5 cases5.5%vs 4 cases1.5%,P=0.038).There was no statistical difference in operation duration,number of lymph node resected and other complications between the two groups (all P>0.05).The 5-year accumulate survival rate of the LABCC group was significantly lower than that of the control group (64.8% vs 82.1%,P=0.001),and the mortality rate was higher (9.9% vs 4.2%,P=0.042).There was no significant difference in the recurrence rate between the two groups (P>0.05). Conclusion The efficacy of surgical treatment for LABCC patients is reliable,and the surgery is recommended to be performed after NACT treatment.The 5-year survival rate of LABCC group is lower and the mortality rate is higher than that of early stage patients.