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.
Highlights
Conventional surgical management of early-stage cervical carcinoma is radical hysterectomy (RH), which is associated with postoperative morbidities like bladder dysfunction, sexual dysfunction and colorectal motility disorders
One was excluded because some patients in the laparoscopic radical hysterectomy (LRH) group underwent a nerve-sparing operation and we were unable, on the basis of the text, to separate out the data for those who received the nerve-sparing procedure and those who received the nonnerve-sparing procedure [12]
Another study was excluded because it involved robot-assisted operation [13], another because some patients underwent laparoscopic operation while others underwent laparotomy [14], and another three because cervical cancer and endometrial carcinoma patients were enrolled together [15,16,17]
Summary
Conventional surgical management of early-stage cervical carcinoma is radical hysterectomy (RH), which is associated with postoperative morbidities like bladder dysfunction, sexual dysfunction and colorectal motility disorders. As a result of advances in minimally invasive surgery, laparoscopic radical hysterectomy (LRH) is performed routinely around the world [5]. While this technique is less invasive than RH, it can still lead to substantial rates of postoperative morbidity. In an effort to reduce postoperative morbidity, many gynecologists have focused on surgical approaches that protect the pelvic nerves that can be damaged during RH. The first approach, called nerve-sparing radical hysterectomy (NSRH), was invented by Japanese gynecologists. We decided to test this belief rigorously by conducting a systematic review of the literature and meta-analysis of pooled studies
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