Clinical Efficacy and Safety of Nerve-Sparing Radical Hysterectomy for Cervical Cancer: A Systematic Review and Meta-Analysis

Abstract

Backgroud and ObjectiveNerve-sparing radical hysterectomy (NSRH) may be associated with lower postoperative morbidity than radical hysterectomy (RH). We aimed to compare the clinical efficacy and safety of abdominal or laparoscopic NSRH and RH for treating cervical cancer through systematic review and meta-analysis.MethodsPubMed, EMBASE, The Cochrane Library and the Chinese National Knowledge Infrastructure databases were systematically searched for all relevant studies. Data were abstracted independently by two reviewers. A meta-analysis was performed to compare intra- and postoperative outcomes for the two techniques.ResultsA total of 17 clinical trials were identified. Meta-analysis showed that although operating time was significantly longer for abdominal or laparoscopic NSRH than for RH, NSRH based on laparotomy or laparoscopy proved more effective for postoperative recovery of bladder function. NSRH was also associated with lower bladder dysfunction morbidity and fewer postoperative complications. Two abdominal trials and one laparoscopic study further suggested that NSRH was associated with shorter time to recovery of anal/rectal function. In contrast, RH and NSRH based on laparotomy or laparoscopy were similar in terms of extent of resection, recurrence rate, survival rate, blood loss and frequency of intraoperative complications. The meta-analysis showed that abdominal NSRH was not significantly different from RH in length of hospital stay, while one trial suggested that length of hospital stay was shorter after laparoscopic NSRH than after the corresponding RH.ConclusionNSRH may be a reliable technique for treating early cervical cancer. Available evidence suggests that it is better than RH for postoperative recovery of pelvic organ function and postoperative morbidity, while the two techniques involve similar clinical safety and extent of resection. These results should be considered preliminary since they are based on a relatively small number of controlled trials, most of which were non-randomized. The findings should be verified in larger, well-designed studies.

Comparison of Nerve-Sparing Radical Hysterectomy and Radical Hysterectomy: a Systematic Review and Meta-Analysis

“…After analyzing 8 studies reported urinary incontinence and 11 studies reported mean time of catheterization respectively, we found that NSRH could significantly decrease urinary incontinence and postoperative mean time of catheterization compared to RH. These results suggested that NSRH was an effective surgical technique with better postoperative bladder function than RH, which was in line with Long and colleagues' findings [33].…”

Evaluation of the association between perineural invasion and clinical and histopathological features of cervical cancer

“…Studies on the safety of NSRN are predominantly focused on the post-operative function of bladder and rectum and sexual activities, however, these studies have a number of limitations such as poor comparison, small sampling size, or shorter follow-up period. Whether NSRH is safer than the traditional radical hysterectomy has not yet been determined (32)(33)(34). Given that PNI of cervical cancer is associated with poor prognosis of cervical cancer patients, NSRH should be carefully recommended for cervical cancer patients with PNI.…”

Nerve-Sparing radical hysterectomy - An old Japanese concept

“…The Tokyo method, developed originally by Ogino (1950) and revised by Kobayashi (1961) and Sakamoto and Takizawa (1988) demonstrated that the cardinal ligament is divided into two parts, the superficial or ventral "vascular part" as a target for ligation and removal and the deep or dorsal "nerve part" that should be preserved because it is likely to contain the pelvic splanchnic nerves. Many Western and Asian gynecologists seem to accept the Tokyo method as a standard method for nerve-sparing radical hysterectomy (2,3,7,16).…”

“…He also demonstrated that pelvic splanchnic nerves runs along the most dorsal part of the cardinal ligament (3).…”