Clinical Effect of Nerve Sparing Radical Hysterectomy for Cervical Cancer: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

LONG Ying ,  YAO Desheng , ZhOU Kechen

Department of Oncology Gynecology, Cancer Hospital of Guang Xi Medical University, Nanning 530021, China;

Corresponding author：

YAO Desheng, Email: yaodeson@163.com

Keywords：

Nerve sparing; Radical hysterectomy; Cervical cancer; Clinical effect; Systematic review

DOI：

10.7507/1672-2531.20100571

Video：

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Objective 　To evaluate the clinical effect and safety of nerve sparing radical hysterectomy(NSRH) for cervical cancer compared with radical hysterectomy (RH).
Methods 　We searched the Cochrane Library (Issue 2, 2010), MEDLINE (1960 to March, 2010), EMbase (1960 to March, 2010), CBM (1960 to March, 2010), VIP (1960 to March, 2010) and CNKI (1960 to March, 2010), and hand searched related literatures. With a defined search strategy, both randomized controlled trials and controlled clinical trials of comparing NSRH with RH for cervical cancer were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trials was evaluated by Cochrane’s evaluation criterion. Meta-analysis was conducted with the Cochrane collaboration’s RevMan 4.2.2 software.
Results 　Nine controlled clinical trials involving 742 patients were identified. The meta-analysis showed that: a) There was statistical significance in postoperative recovery of bladder function between two groups; compared with RH, NSRH was much better in aspects of the recovery time of post void residual urine volume (PVR) (WMD= – 5.80, 95%CI – 6.22 to – 5.37), the bladder dysfunction morbidity (RR=0.43, 95%CI (0.26 to 0.75), and the urodynamic study; b) The operation time of NSRH was longer than that of RH with a significant difference (WMD=37.23, 95%CI 12.84 to 61.61); c) There was no significant difference between two groups in bleeding amount (WMD=19.66, 95%CI – 51.57 to 90.90); d) There was no significant difference between two groups in both survival rate and recurrent rate (RR=0.79, 95%CI 0.17 to 3.58); e) There was no significant difference between two groups in resection extension and pathologic outcome, such as, infiltration around uterus and vessels; f) One trail showed a significant difference between two groups that NSRH seldom led to anorectal and sexual dysfunction.
Conclusions 　Compared with RH, NSRH can quickly improve the postoperative recovery of bladder, anorectal and sexual functions, but haven’t larger quantity of operative bleeding, larger resection extension, lower survival rates and higher recurrence rates except longer operation time. NSRH can improve the quality of postoperative life and is safe. However, the trails available for this systematic review were limited, as well as non-randomized controlled trails. Some outcomes were only included by one trail. So there is no confirmed conclusion about these. The prospective randomized controlled trials are required for further investigation.

Citation： LONG Ying,YAO Desheng,ZhOU Kechen. Clinical Effect of Nerve Sparing Radical Hysterectomy for Cervical Cancer: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2010, 10(10): 1205-1212. doi: 10.7507/1672-2531.20100571 Copy

1.	Deeks JJ, Dmoes J, D’amico, et al. Evalusting non-randomized intervention studies. Health Technol Assess, 2003, 7(27): ⅲ-x，1-173.
2.	李艳, 梁志清, 陈勇, 等. 腹腔镜下保留盆腔神经丛的根治性子宫切除术的临床观察. 重庆医学, 2009, 38(15): 1910-1912.
3.	陈勇, 李燕, 徐惠成, 等. 腹腔镜下保留盆腔植物神经的解剖性广泛性子宫切除术37例临床分析. 中华妇产科杂志, 2009, 44(5): 359-362.
4.	张勇, 王丹, 马瑛, 等. 腹腔镜保留神经宫颈癌根治术的临床研究. 现代妇产科进展, 2010, 19(1): 30-32.
5.	Possover M, Stober S, Plaul K, et al. Identification and preservation of the motoric innervation of the bladder in radical hysterectomy type Ⅲ. Gynecol Oncol, 2000, 79(2): 154-157.
6.	Yabuki Y, Asamoto A, Hoshiba T, et al. Radical hysterectomy: An anatomic evaluation of parametrial dissection. Gynecol Oncol, 2000, 77(1): 155-163.
7.	居杏珠, 李子庭, 杨慧娟, 等. 子宫颈癌保留神经广泛性子宫切除术与传统广泛性子宫切除术的比较性研究. 中华妇产科杂志, 2009, 44(8): 605-609.
8.	陈春林, 郭红霞, 刘萍等. 根治性子宫切除术中系统保留盆腔自主神经的临床研究. 中国实用妇科与产科杂志, 2009, (03): 206-209.
9.	吴义勋, 邱实. 保留盆丛神经的子宫颈癌根治术后排尿功能. 中华妇产科杂志, 1991, 26(6): 368-371.
10.	Sakuragi N, Todo Y, Kudo M, et al. A systematic nerve-sparing radical hysterectomy technique in invasive cervical cancer for preserving postsurgical bladder function. Int J Gynecol Cancer, 2005, 15(2): 389-397.
11.	Raspagliesi F, Ditto A, Fontanelli R, et al. Type II versus Type III nerve-sparing radical hysterectomy: comparison of lower urinary tract dysfunctions. Gynecol Oncol, 2006, 102(2): 256-262.
12.	Todo Y, Kuwabara M, Watari H, et al. Urodynamic study on postsurgical bladder function in cervical cancer treated with systematic nerve-sparing radical hysterectomy. Int J Gynecol Cancer, 2006, 16(1): 369-375.
13.	李斌, 张蓉, 吴令英, 等. 保留盆腔植物神经的广泛性子宫切除术治疗子宫颈癌的初步研究. 中华妇产科杂志, 2008, 43(8): 606-610.
14.	孙力, 吴令英, 章文华, 等. 根治性子宫切除术中保留盆腔自主神经的初步研究. 中华肿瘤杂志, 2009, 31(8): 607-611.
15.	Skret-Magierlo J, Narog M, Kruczek A, et al. Radical hysterectomy during the transition period from traditional to nerve-sparing technique. Gynecol Oncol, 2010, 116(3): 502-505.
16.	Cibula D, Velechovska P, Slama J, et al. Late morbidity following nerve-sparing radical hysterectomy. Gynecol Oncol, 2010, 116(3): 506-511.
17.	van den Tillaart SA v, Kenter GG, Peters AA, et al. Nerve-sparing radical hysterectomy: local recurrence rate, feasibility, and safety in cervical cancer patients stage IA to IIA. Int J Gynecol Cancer, 2009, 19(1): 39-45.
18.	Fujii S, Takakura K, Matsumura N, et al. Anatomic identification and functional outcomes of the nerve sparing Okabayashi radical hysterectomy. Gynecol Oncol, 2007, 107(1): 4-13.
19.	Mantzaris G, Rodolakis A, Vlachos G, et al. Magnifying lenses assisted nerve-sparing radical hysterectomy and prevention of nerve plexus trauma. Int J Gynecol Cancer, 2008, 18(4): 868-875.
20.	Charoenkwan K, Srisomboon J, Suprasert P, et al. Nerve-sparing class III radical hysterectomy: a modified technique to spare the pelvic autonomic nerves without compromising radicality. Int J Gynecol Cancer, 2006, 16(4): 1705-1712.
21.	Pieterse QD, Ter KMM, Deruiter MC, et al. Vaginal blood flow after radical hysterectomy with and without nerve sparing. A preliminary report. Int J Gynecol Cancer, 2008, 18(3): 576-583.
22.	Trimbos JB, Maas CP, Deruiter MC, et al. A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients. Int J Gynecol Cancer, 2001, 11(3): 180-186.
23.	Hockel M, Konerding MA, Heussel CP. Liposuction-assisted nerve-sparing extended radical hysterectomy: oncologic rationale, surgical anatomy, and feasibility study. Am J Obstet Gynecol, 1998, 178(5): 971-976.
24.	Kuwabara Y, Suzuki M, Hashimoto M, et al. New method to prevent bladder dysfunction after radical hysterectomy for uterine cervical cancer. J Obstet Gynaecol Res, 2000, 26(1): 1-8.

1. Deeks JJ, Dmoes J, D’amico, et al. Evalusting non-randomized intervention studies. Health Technol Assess, 2003, 7(27): ⅲ-x，1-173.
2. 李艳, 梁志清, 陈勇, 等. 腹腔镜下保留盆腔神经丛的根治性子宫切除术的临床观察. 重庆医学, 2009, 38(15): 1910-1912.
3. 陈勇, 李燕, 徐惠成, 等. 腹腔镜下保留盆腔植物神经的解剖性广泛性子宫切除术37例临床分析. 中华妇产科杂志, 2009, 44(5): 359-362.
4. 张勇, 王丹, 马瑛, 等. 腹腔镜保留神经宫颈癌根治术的临床研究. 现代妇产科进展, 2010, 19(1): 30-32.
5. Possover M, Stober S, Plaul K, et al. Identification and preservation of the motoric innervation of the bladder in radical hysterectomy type Ⅲ. Gynecol Oncol, 2000, 79(2): 154-157.
6. Yabuki Y, Asamoto A, Hoshiba T, et al. Radical hysterectomy: An anatomic evaluation of parametrial dissection. Gynecol Oncol, 2000, 77(1): 155-163.
7. 居杏珠, 李子庭, 杨慧娟, 等. 子宫颈癌保留神经广泛性子宫切除术与传统广泛性子宫切除术的比较性研究. 中华妇产科杂志, 2009, 44(8): 605-609.
8. 陈春林, 郭红霞, 刘萍等. 根治性子宫切除术中系统保留盆腔自主神经的临床研究. 中国实用妇科与产科杂志, 2009, (03): 206-209.
9. 吴义勋, 邱实. 保留盆丛神经的子宫颈癌根治术后排尿功能. 中华妇产科杂志, 1991, 26(6): 368-371.
10. Sakuragi N, Todo Y, Kudo M, et al. A systematic nerve-sparing radical hysterectomy technique in invasive cervical cancer for preserving postsurgical bladder function. Int J Gynecol Cancer, 2005, 15(2): 389-397.
11. Raspagliesi F, Ditto A, Fontanelli R, et al. Type II versus Type III nerve-sparing radical hysterectomy: comparison of lower urinary tract dysfunctions. Gynecol Oncol, 2006, 102(2): 256-262.
12. Todo Y, Kuwabara M, Watari H, et al. Urodynamic study on postsurgical bladder function in cervical cancer treated with systematic nerve-sparing radical hysterectomy. Int J Gynecol Cancer, 2006, 16(1): 369-375.
13. 李斌, 张蓉, 吴令英, 等. 保留盆腔植物神经的广泛性子宫切除术治疗子宫颈癌的初步研究. 中华妇产科杂志, 2008, 43(8): 606-610.
14. 孙力, 吴令英, 章文华, 等. 根治性子宫切除术中保留盆腔自主神经的初步研究. 中华肿瘤杂志, 2009, 31(8): 607-611.
15. Skret-Magierlo J, Narog M, Kruczek A, et al. Radical hysterectomy during the transition period from traditional to nerve-sparing technique. Gynecol Oncol, 2010, 116(3): 502-505.
16. Cibula D, Velechovska P, Slama J, et al. Late morbidity following nerve-sparing radical hysterectomy. Gynecol Oncol, 2010, 116(3): 506-511.
17. van den Tillaart SA v, Kenter GG, Peters AA, et al. Nerve-sparing radical hysterectomy: local recurrence rate, feasibility, and safety in cervical cancer patients stage IA to IIA. Int J Gynecol Cancer, 2009, 19(1): 39-45.
18. Fujii S, Takakura K, Matsumura N, et al. Anatomic identification and functional outcomes of the nerve sparing Okabayashi radical hysterectomy. Gynecol Oncol, 2007, 107(1): 4-13.
19. Mantzaris G, Rodolakis A, Vlachos G, et al. Magnifying lenses assisted nerve-sparing radical hysterectomy and prevention of nerve plexus trauma. Int J Gynecol Cancer, 2008, 18(4): 868-875.
20. Charoenkwan K, Srisomboon J, Suprasert P, et al. Nerve-sparing class III radical hysterectomy: a modified technique to spare the pelvic autonomic nerves without compromising radicality. Int J Gynecol Cancer, 2006, 16(4): 1705-1712.
21. Pieterse QD, Ter KMM, Deruiter MC, et al. Vaginal blood flow after radical hysterectomy with and without nerve sparing. A preliminary report. Int J Gynecol Cancer, 2008, 18(3): 576-583.
22. Trimbos JB, Maas CP, Deruiter MC, et al. A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients. Int J Gynecol Cancer, 2001, 11(3): 180-186.
23. Hockel M, Konerding MA, Heussel CP. Liposuction-assisted nerve-sparing extended radical hysterectomy: oncologic rationale, surgical anatomy, and feasibility study. Am J Obstet Gynecol, 1998, 178(5): 971-976.
24. Kuwabara Y, Suzuki M, Hashimoto M, et al. New method to prevent bladder dysfunction after radical hysterectomy for uterine cervical cancer. J Obstet Gynaecol Res, 2000, 26(1): 1-8.

Chinese Journal of Evidence-Based Medicine

Clinical Effect of Nerve Sparing Radical Hysterectomy for Cervical Cancer: A Systematic Review

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