[Evaluation of postoperative bladder function and prognosis after modified nerve sparing radical hysterectomy].

OBJECTIVE: To compare the nerve plane sparing radical hysterectomy (NPSRH) with conventional radical hysterectomy (CRH) in terms of postoperative bladder function and prognosis. METHODS: One hundred and two patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ib1-IIa2 cervical cancer were treated by open NPSRH (study group) from January 2008 to March 2013. During the same time periods, two hundred and four patients who underwent open CRH were randomly selected as the control group. Age, pathological type and FIGO stage were matched. RESULTS: The median operation time in NPSRH group and CRH group were 268.8 and 242.4 minutes, respectively (P < 0.01). The median hospital stay were 14.6 and 17.2 days (P < 0.01). The median volume of blood loss in the two groups were respectively 394 and 450 ml (P > 0.05). The blood transfusion rate was respectively 46.1% (47/102) and 41.7% (85/204; P > 0.05). The rate of postoperative complications were not significantly difference [14.7% (15/102) vs 11.8% (24/204), P > 0.05]. The median duration of catheterization was 9.1 and 15.2 days between two groups (P < 0.01). Eighty-five patients in NPSRH group and one hundred and sixty-seven patients in CRH group completed the telephone interview about the long-term bladder function. The incidence of long-term urinary frequency [14.1% (12/85) vs 33.5% (56/167)], urinary incontinence [36.5% (31/85) vs 54.5% (91/167) ], urinary retention [23.5% (20/85) vs 38.9% (65/167) ] and straining to void [10.6% (9/85) vs 40.7% (68/167)], there were significantly lower in NPSRH group than those in CRH group ( all P < 0.05). The rate of recurrence was 10.8% (11/102) in NPSRH group and 12.2% (25/204) in CRH group (P = 0.707). Three-year recurrence-free survival (RFS) estimate was 88.5% in NPSRH group and 91.1% in CRH group (P = 0.746). Three-year overall survival (OS) estimate was 93.7% in NPSRH group and 96.3% in CRH group (P = 0.701). The univariate analysis shown that pathological type, lymph node metastases, and lymph-vascular space invasion (LVSI) presented the trend for a worst 3-year RFS and OS (P < 0.05) . The multivariate analyses shown that both pathological type and lymph node metastases were associated with a worst 3-year RFS (P < 0.05) . Lymph node metastases was a significant independent predictor of 3-year OS (P = 0.001) . NPSRH was not a significant independent predictor by Cox regression model analyses. CONCLUSION: NPSRH contributes to bladder function recovery without compromising survival.

Evaluation of pelvic visceral functions after modified nerve-sparing radical hysterectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Nerve-sparing radical hysterectomy (NSRH) was developed in an attempt to minimize complications after radical hysterectomy. Since 2008, a modified NSRH-nerve plane-sparing radical hysterectomy (NPSRH) has been developed at the Cancer Hospital, Chinese Academy of Medical Sciences. The aim of this study was to investigate the role of NPSRH in improving postoperative pelvic visceral dysfunctions.</p><p><b>METHODS</b>Eighty-three patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB1-IIA2 cervical cancer received NPSRH (the study group) from January 2008 to October 2012. One hundred and sixty-six patients who underwent conventional radical hysterectomy (CRH) were randomly selected as the control group. Age, pathological type and stage were matched between the two groups. The safety of surgery was assessed by duration of operation and blood transfusion rate. Postoperative short-term bladder function was analyzed by duration of catheterization. Long-term bladder, anorectal and sexual function were evaluated with questionnaires.</p><p><b>RESULTS</b>Seventy-eight patients (94.0%) in the NPSRH group and one hundred and sixty patients (96.4%) in the CRH group completed the study. Median follow-up time was 31.9 months and 31.0 months respectively (P = 0.708). There was no significant difference between the two groups in terms of age, body mass index, FIGO stage, pathologic type, preoperative and postoperative therapy (P > 0.05). The blood transfusion rate shared no difference between two groups (P = 0.364). The operation time in the NPSRH group was significantly longer than CRH group (P < 0.01). But the duration of catheterization and hospitalization in the NPSRH group was significantly reduced compared with CRH group (P < 0.01). In addition, the incidence of long-term urinary frequency, urinary incontinence, urinary retention, straining to void, constipation and diarrhea was significantly lower in the NPSRH group (P < 0.05). However, there was no significant difference regarding sexual function (P > 0.05).</p><p><b>CONCLUSIONS</b>The current evidence indicated that NPSRH improved long-term bladder function compared to CRH. Moreover, it may improve long-term anorectal function as well.</p>

Application of laparoscopy in the modified nerve plane-sparing radical hysterectomy of cervical cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The aim of this study was to assess the feasibility and safety of laparoscopic nerve plane-sparing radical hysterectomy (NPSRH) and compare with that of open NPSRH.</p><p><b>METHODS</b>One hundred and thirty-four patients with FIGO stage Ib1-IIa2 cervical cancer were enrolled in the study. Thirty-three patients underwent laparoscopic NPSRH. During the operation, the pelvic autonomic nerve plane which is directly underneath the ureter was integrally preserved by dissecting the pelvic spaces laparoscopically. The vessels around the nerve plane were controlled by Hem-o-lok polymer clips. One hundred and one patients underwent open NPSRH without special instruments. The clinical, pathological and surgery-related parameters were compared between the two groups. Moreover, postoperative short-term bladder function of these patients was also analyzed.</p><p><b>RESULTS</b>There was no significant difference between the laparoscopic group and open group in terms of age, body mass index, previous surgery, FIGO stage, pathologic type, etc. (P > 0.05). The mean duration of surgery in the laparoscopic group was significantly longer [(303.8 ± 67.5) min vs. (272.4 ± 57.5) min] (P < 0.01). But, the laparoscopic group had less blood loss [177.0 ml vs. 474.5 ml, P < 0.01] and blood transfusion rate [ 6.1% (2/33 cases) vs. 49.5% (50/101 cases), P < 0.001]. There was no significant difference regarding the proportion of patients who firstly passed the post-void residual urine volume (PVR) test (P > 0.05). The median time of catheterization between the two groups were also comparable (P > 0.05). However, the postoperative hospital stay was significantly shorter in the laparoscopic group [median postoperative hospital stay 9.2 days vs. 11.0 days, P < 0.001].</p><p><b>CONCLUSIONS</b>Laparoscopic NPSRH is feasible. It seems to be comparable with open NPSRH in terms of preserving pelvic nerve function, but is more favorable in terms of blood loss and postoperative recovery.</p>