2794 Nerve Sparing Radical Hysterectomy Versus Conventional Radical Hysterectomy in Early-Stage Cervical Cancer: A Systematic Review And Meta-Analysis

Abstract

Study Objective To compare the oncologic outcome of nerve-sparing radical hysterectomy and conventional radical hysterectomy through meta-analysis. Design A systematic review and meta-analysis of 4 randomized controlled trials, 8 case-control, and 11 comparative cohort studies that compared the morbidity and pelvic dysfunctions, and oncologic outcomes in both surgical methods. Setting A total of 23 studies were included in this meta-analysis; included studies reporting data of patients affected by cervical cancer; included studies written in English language; included studies including ≥20 patients; included studies reporting data of patients with a comparison of clinical outcomes between nerve-sparing radical hysterectomy and conventional radical hysterectomy. Data were extracted and risk of bias was assessed by four independent reviewers. Patients or Participants Overall, 1769 patients were included: 884 (49.2%) and 912 (50.8%) patients undergoing nerve-sparing radical hysterectomy and conventional radical hysterectomy, respectively. Interventions The meta-analyses were conducted using software designed for composing Cochrane reviews (Review Manager Version 5.3). Measurements and Main Results Looking at perioperative parameters, we observed that nerve-sparing radical hysterectomy was associated with a lower intraoperative blood loss and a shorter length of hospital stay in comparison with conventional radical hysterectomy. Patients undergoing nerve-sparing radical hysterectomy experienced lower urinary, colorectal, and sexual dysfunctions than patients undergoing conventional radical hysterectomy. Among parametric factors, resected parametrial widths was favorable in patients with conventional radical hysterectomy. This result suggests that nerve-sparing radical hysterectomy is inferior to conventional radical hysterectomy in its radicality. The 5-year disease free survival and 5-year overall survival rates were similar between groups. Conclusion The collected data up to now demonstrated that the nerve-sparing approach guarantees minimized surgical-related pelvic dysfunctions, similar oncologic outcomes as conventional radical hysterectomy. However, because of the low quality of the articles included, more evidence is needed. Further RCTs should be conducted to strengthen the superiority and safety of NSRH.