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

Authors Chang WF, Luo AJ, Yuan YF, Chen Y, Xin ZR, Xu SS

Received 28 December 2019

Accepted for publication 22 May 2020

Published 12 June 2020 Volume 2020:12 Pages 4483—4492


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Sanjeev Srivastava

Wei-Fu Chang,1– 3 Ai-Jing Luo,1,3,4 Yi-Feng Yuan,5 Yang Chen,5 Zi-Rui Xin,3,5 Shuai-Shuai Xu1

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

Correspondence: Ai-Jing Luo
The Second Xiangya Hospital of Central South University, 139 Renmin Middle Road, Furong District, Changsha 410011, Hunan, People’s Republic of China

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

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