Radical surgery for cervical cancer
Menée auprès d'une cohorte de 523 patientes atteintes d'un cancer du col utérin de stade IB1, IB2, IIA1, IIA2 ou IIB (durée médiane de suivi : 61,8 mois), cette étude évalue l'efficacité, du point de vue de la survie spécifique et de la survie sans récidive à 5 ans, et les complications d'une résection chirurgicale et d'un curage ganglionnaire dont les protocoles sont basés sur le développement embryonnaire et fœtal des tissus
In The Lancet Oncology, Michael Höckel and colleagues 1report the long-term results of a prospective cohort study assessing the role of cancer field resection in cervical cancer. Mesometrial resection is aimed at removing the embryologically defined uterovaginal (ie, Müllerian) compartment consisting of the Fallopian tubes, uterus, and proximal and middle vagina enveloped by topographically complex peritoneal and retroperitoneal mesometrium. The study cohort included 523 patients with 2009 FIGO stage IB1–IIB cervical cancer who underwent total or extended mesometrial resection plus lymphadenectomy without adjuvant radiotherapy. The median follow-up was 61·8 months (IQR 49·3–94·8). The study population, of which 150 (29%) of 523 patients had positive lymph nodes and 160 (31%) had stage IIB disease, had a 5-year overall survival of 87·9% (95% CI 84·8–91·1). 1This survival estimate, albeit a secondary outcome of the study, exceeded those reported elsewhere. For instance, available data from the Surveillance, Epidemiology, and End Results programme suggested that 5-year overall survival is about 55–60% for patients with lymph node metastasis and in patients with locally advanced cervical cancer. 2Similarly, the Cancer Research UK estimated that the 5-year overall survival for stage II cervical cancer is about 55%. 3 These differences lead to the hypothesis, although indirectly, that mesometrial resection is associated with improved local control and survival. However, it is unlikely that modifying the surgical approach resulted in a greater than 30% improvement in survival. Patient selection might have a role in explaining these results.