Efficacy and oncologic safety of nerve-sparing radical hysterectomy for cervical cancer: a randomized controlled trial

Abstract

ObjectiveA prospective, randomized controlled trial was conducted to evaluate the efficacy of nerve-sparing radical hysterectomy (NSRH) in preserving bladder function and its oncologic safety in the treatment of cervical cancer.MethodsFrom March 2003 to November 2005, 92 patients with cervical cancer stage IA2 to IIA were randomly assigned for surgical treatment with conventional radical hysterectomy (CRH) or NSRH, and 86 patients finally included in the analysis. Adequacy of nerve sparing, radicality, bladder function, and oncologic safety were assessed by quantifying the nerve fibers in the paracervix, measuring the extent of paracervix and harvested lymph nodes (LNs), urodynamic study (UDS) with International Prostate Symptom Score (IPSS), and 10-year disease-free survival (DFS), respectively.ResultsThere were no differences in clinicopathologic characteristics between two groups. The median number of nerve fiber was 12 (range, 6 to 21) and 30 (range, 17 to 45) in the NSRH and CRH, respectively (p<0.001). The extent of resected paracervix and number of LNs were not different between the two groups. Volume of residual urine and bladder compliance were significantly deteriorated at 12 months after CRH. On the contrary, all parameters of UDS were recovered no later than 3 months after NSRH. Evaluation of the IPSS showed that the frequency of long-term urinary symptom was higher in CRH than in the NSRH group. The median duration before the postvoid residual urine volume became less than 50 mL was 11 days (range, 7 to 26 days) in NSRH group and was 18 days (range, 10 to 85 days) in CRH group (p<0.001). No significant difference was observed in the 10-year DFS between two groups.ConclusionNSRH appears to be effective in preserving bladder function without sacrificing oncologic safety.

Favorable factors for preserving bladder function after nerve‐sparing radical hysterectomy: A protocol‐based validation study

“…In particular, the two favorable factors did not lead to a difference in PFS between NSRH and CRH. This finding supports the hypothesis that NSRH may result in comparable oncologic outcomes to CRH, which has been found in several studies …”

“…Although many factors including inflammation, local oedema, electrical burn damage, and reduced blood flow can cause voiding difficulty immediately after CRH, surgical injury of the pelvic autonomic nerves is known to be the most important factor for developing postoperative bladder dysfunction . Thus, NSRH has begun to receive much attention globally after the discovery that sympathetic nerves in the hypogastric nerve and the vesical branch of the pelvic plexus may control the detrusor muscle of the bladder and urethral sphincter, and the beneficial effects of NSRH on postoperative bladder dysfunction have been reported in several RCTs and meta‐analyses …”

Cancer of the cervix uteri

“…hypogastric nerve, splanchnic nerve, and pelvic plexus) often lead to impairment of urination, defecation, and sexual function, and consequent deterioration of the postoperative quality of life (QOL). 55,56 In young women desiring fertility sparing, a radical trachelectomy may be performed, indicated for Stage IA2-IB1 tumors measuring less than or equal to 2 cm in largest diameter. 57 The 63 Further studies may be required to further confirm these findings.…”

Clinical effect of Fuzheng quyu therapy in patients undergoing radiotherapy after cervical carcinoma surgery

“…Many physicians, both in China and elsewhere, have evaluated the various treatments in detail. Roh et al [9] performed a prospective, randomized controlled study on 86 patients with cervical cancer who were randomly divided into a radical hysterectomy group (with pelvic nerve preservation) and a conventional radical hysterectomy group. Preservation of the cervical nerve improved the QoL.…”