Efficacy and oncologic safety of nerve-sparing radical hysterectomy for cervical cancer: a randomized controlled trial.
- Author:
Ju Won ROH
1
;
Dong Ock LEE
;
Dong Hoon SUH
;
Myong Cheol LIM
;
Sang Soo SEO
;
Jinsoo CHUNG
;
Sun LEE
;
Sang Yoon PARK
Author Information
- Publication Type:Original Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
- Keywords: Disease-Free Survival; Hysterectomy; Urinary Bladder, Neurogenic; Uterine Cervical Neoplasms
- MeSH: Adenocarcinoma/mortality/pathology/surgery; Adult; Carcinoma, Adenosquamous/mortality/pathology/surgery; Carcinoma, Squamous Cell/mortality/pathology/surgery; Female; Humans; Hysterectomy/adverse effects/*methods; Middle Aged; *Organ Sparing Treatments/adverse effects/methods; Pelvis/*innervation/surgery; Recovery of Function; Survival Analysis; Treatment Outcome; Urinary Bladder/*innervation/physiology/surgery; Uterine Cervical Neoplasms/mortality/pathology/*surgery; Uterus/*innervation/surgery
- From:Journal of Gynecologic Oncology 2015;26(2):90-99
- CountryRepublic of Korea
- Language:English
- Abstract: OBJECTIVE: A 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. METHODS: From 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. RESULTS: There 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. CONCLUSION: NSRH appears to be effective in preserving bladder function without sacrificing oncologic safety.
