Type B versus Type C Radical Hysterectomy After Neoadjuvant Chemotherapy in Locally Advanced Cervical Carcinoma: A Propensity-Matched Analysis

Objective: The aim of this study was to evaluate the feasibility and safety of type B radical hysterectomy (RH) in the management of patients affected by locally advanced cervical cancer with favorable prognostic factors (tumor diameter <40 mm, negative nodes, or lymphovascular space involvement) and clinical response to neoadjuvant chemotherapy (NACT). Methods: The data of women undergoing platinum-based NACT followed by RH plus bilateral systematic pelvic lymphadenectomy were collected. Patients undergoing type B RH (Group A) were compared with those undergoing type C RH (Group B); a propensity-matched comparison (1:1) was carried out to minimize selection biases. Postoperative complications were reported and 5-year survival outcomes were assessed using the Kaplan–Meier model. Results: Thirty-six node-negative patients undergoing type B RH (Group A) were compared with 36 propensity-matched patients undergoing type C RH (Group B). The bladder dysfunction rate was significantly lower in Group A compared with Group B (13.9 vs. 69.4 %; p < 0.0001), and no statistically significant difference in 5-year overall survival (OS) and disease-free survival (DFS) between groups was reported (OS 93.0 vs. 96.7 %, p = 0.42; DFS 88.6 and 85.5 %, p = 0.77). Conclusions: Type B RH after NACT in well-selected patients is a safe procedure that upholds the results of type C, reducing operative time and late postoperative morbidity, without detrimental effect on survival. Further prospective trials are warranted to confirm our results on a large scale.