Efficacy of nerve‑sparing radical hysterectomy vs. conventional radical hysterectomy in early‑stage cervical cancer: A systematic review and meta‑analysis

Abstract

The aim of the present study was to compare the oncological outcome of nerve-sparing radical hysterectomy (NSRH) and conventional radical hysterectomy (CRH) for early-stage cervical cancer using a meta-analysis. A systematic review and meta-analysis was conducted, including 4 randomized controlled trials (RCT), 8 case-control and 11 comparative cohort studies comparing the morbidity, pelvic dysfunctions and oncological outcome between the two surgical methods. A total of 23 studies were included in this meta-analysis. The studies reported data of patients affected by cervical cancer; were written in English; included ≥20 patients; and reported data of patients with a comparison of clinical outcomes between NSRH and CRH. Data were extracted and risk of bias was assessed by four independent reviewers. A total of 1,796 patients were included: 884 patients (49.2%) undergoing NSRH and 912 (50.8%) undergoing CRH. The meta-analyses were conducted using Review Manager version 5.3 software, which is designed for conducting Cochrane reviews. As regards perioperative parameters, NSRH was found to be associated with a lower intraoperative blood loss and a shorter length of hospital stay in comparison with CRH. Patients undergoing NSRH experienced lower incidence of urinary, colorectal and sexual dysfunction compared with patients undergoing CRH. However, the resected parametrial width was favorable in patients with CRH, suggesting that NSRH was inferior to CRH in terms of radicality. The 5-year disease-free and overall survival rates were similar between the two groups. In this systematic review and meta-analysis, the collected data to date demonstrated that the nerve-sparing approach guarantees minimized surgical-related pelvic dysfunction, with similar oncological outcomes as CRH. However, further RCTs should be conducted to confirm the superiority and safety of NSRH.

Nerve-sparing in Gynecologic Surgery: A Perspective

“…High residual urine and days of catheterization are significantly less with type C1 [1−6] (Table 2). Rectal dysfunction is significantly lower with type C1 [1], and postoperative constipation is comparable with type C2 or significantly lower. Sexual dysfunction is dependent on the outcome studied.…”

“…Sexual dysfunction is dependent on the outcome studied. Overall sexual function [1], analyzed by the female sexual function index [5], and sexual interest [6] are significantly higher with type C1 [1]. However, there are no differences in dyspareunia, orgasm, satisfaction, or vaginal dryness [6] as compared with type C2.…”

“…Because the portion of the parametrium below the deep uterine vein is preserved in type C1, there was concern for the oncologic outcomes. There is general agreement that disease-free survival and overall survival are comparable with type C2 [1][2][3]6]. There was also concern for local and overall recurrence because of the size of parametrial and vaginal margins, which although are usually comparable [6], some reported a reduced size of the margins [1,4].…”

“…Summarized results of 5 systematic reviews and metaanalyses [1−5] and 1 meta-analysis [6] comparing type C1 with C2 are presented in Tables 1 and 2. There are no major perioperative disadvantages as not to recommend NS radical hysterectomy. In type C1, the operating times are longer (8−30 minutes) or similar to type C2; the blood loss is lower or similar; the length of hospital stay is shorter or comparable; and complication rates are akin [1][2][3][4]6].…”

A Novel Direct Approach to the Deep Uterine Vein in Laparoscopic Radical Hysterectomy

“…Nerve-sparing Okabayashi's radical hysterectomy (NS-RH) was originally aimed at achieving both radical resection and function preservation [1][2][3] . A key procedure when performing NS-RH is intraoperative identification of the relationship between the deep uterine vein and pelvic splanchnic nerve fibers 4 .…”