Retrospective Observational Study of Surgically Treated Patients of Locally Advanced Cervical Cancer After Primary Chemo Radiation at A Tertiary Care Centre in Bihar

Background: The standard advocated line of treatment of locally advanced cervical cancer is concurrent chemo radiotherapy. Still, there are some discussions about completion surgery following chemo radiation and their benefits in the survival of patients. This study aims at studying the feasibility of such surgery and to document any significant complications and morbidity due to such surgery. Methods: 17 patients with cancer of the cervix of stage IIB to IIIB who showed residual disease following concurrent chemo radiation and who consented to the trial were recruited from December 2015 to June 2017. 16 patients underwent laparotomy and type 2 hysterectomy and one patient was found to be inoperable on laparotomy. The operative time, blood loss, intra and post-operative complications and duration of hospital stay were recorded and analyzed. Results: From December 2015 to June 2017, 16 patients were operated. The median age was 55 years (range, 33-65 years). Histologic finding revealed squamous cell carcinoma in 15 (93.75%) cases and adenocarcinoma in 1 (6.25%) cases. International Federation of Gynecology and Obstetrics stages distribution were as follow: IIB, n = 9 (56.25%); IIIA, n = 1 (6.25%); and IIIB, n = 6 (37.50%). Mean estimated blood loss was 400 mL (range, 250-800 ml),and mean operative time was approximately 102 minutes (range, 85-130 minutes). Hospital stay was in average 12 days (range, 10-21 days). Out of 16 cases 4 patients had wound infection, 2 had paralytic ileus, 3 patients had urinary tract infection and 2 developed bladder atony. Secondary resuturing was required in one patient and one patient developed incisional hernia. The patients are on follow up. Conclusion: Completion surgery by trained surgeons on properly selected patients in institutional settings can be carried out with minimal morbidity to the patients. The effectiveness of this surgery and survival benefits to the patients’ needs to be investigated in bigger trials.