Success Factors of Laparoscopic Nerve-sparing Radical Hysterectomy for Preserving Bladder Function in Patients with Cervical Cancer: A Protocol-Based Prospective Cohort Study.

Abstract

Success factors of laparoscopic nerve-sparing radical hysterectomy (LNRH) to preserve bladder function are little known despite its widespread use. Thus, we conducted a protocol-based prospective cohort study to evaluate clinicopathologic factors for preserving autonomic nerves and its impact on duration of postoperative catheterization (DPC). From 2012 to 2014, 30 patients with stage IB1 to IIA2 cervical cancer were recruited prospectively to undergo LNRH. All procedures were performed on the left side of the patients by one gynecologic oncologist. Extent of resection and preservation of autonomic nerves were documented in the protocol during LNRH. All patients received laparoscopic type C1 radical hysterectomy, where extent of resection and preservation of autonomic nerves were not different between the right and left sides. Stage IB1 disease was associated with the reduced risk of injury of the left junctions between the hypogastric and the splanchnic nerves; between the splanchnic nerve and the vesical branch of the pelvic plexus (S-V junction) (adjusted odds ratios, 0.06 and 0.06; 95 % confidence intervals, 0.01-0.92 and 0.01-0.48); the right S-V junction with marginal significance (adjusted odds ratio, 0.18; 95 % confidence interval, 0.03-1.06). Furthermore, bilateral preservation of autonomic nerves decreased DPC significantly when compared with failure or unilateral preservation (median, 6 days vs. 34 days or 57 days; P < 0.05). LNRH has a higher likelihood of its success in stage IB1 than in stage IB2 to IIA disease. Moreover, preservation of bilateral autonomic nerves reduces DPC significantly in comparison with failure or unilateral preservation.