Morbidité de la chirurgie de clôture après radio-chimiothérapie chez des patientes atteintes d'un cancer du col de stade avancé

Objective: To evaluate the morbidity rate in patients following completion surgery (hysterectomy ± lymphadenectomy) after chemoradiation therapy (CRT) for an advanced stage cervical cancer. Patients and methods: Patients fulfilling the following inclusion criteria were studied: (1) stage IB2-IVA cervical carcinoma; (2) tumor initially confined to the pelvic cavity; (3) pelvic external radiation therapy with delivery of 45 Gy with concomitant chemotherapy (cisplatin 40 mg/m²/week) followed by utero-vaginal brachytherapy; (4) completion surgery after the end of radiation therapy including at least a hysterectomy. Results: One-hundred and fifty patients treated between 1998 and 2007 fulfilled inclusion criteria. Thirty-seven (25%) patients had 55 post-operative complications (17 had severe complications requiring surgical or radiological treatment). Two deaths related to postoperative morbidity had occurred. The risk of complications was increased with a radical hysterectomy (OR = 2.4; P = 0.04) and the presence of residual cervical disease (≤1 cm: OR = 4.3, >1 cm: OR = 2.5; P = 0.01). Conclusion: In the present study, the morbidity of completion surgery (based on hysterectomy with or without lymphadenectomy) is very high in patients treated with initial CRT for locally advanced cervical cancer whereas the therapeutic value of such surgery remains unproven.