Clinical efficacy and safety of nerve-sparing radical hysterectomy for cervical cancer: a systematic review and meta-analysis

Abstract

Backgroud and objective: Nerve-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.

Methods: PubMed, 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.

Results: A 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.

Conclusion: NSRH 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.

Figure 1. Flowchart of study selection.

Figure 2. Forest plots comparing NSRH with RH in terms of (a) intraoperative blood loss, (b) operating time and (c) length of hospital stay.

Figure 3. Forest plots comparing NSRH with RH in terms of (a) time to achieve normal post-void residual urine volume, (b) intra- and postoperative complications and (c) bladder dysfunction.

Figure 4. Forest plots comparing LNSRH with LRH in terms of (a) intraoperative blood loss, (b) operating time, (c) time to recover bladder function based on post-void residual (PVR) urine volume, (d) bladder function recovery based on postoperative sensation of bladder fullness and (e) bladder function recovery based on postoperative satisfaction with micturition.

Figure 5. Forest plots comparing LNSRH with LRH in terms of bladder function recovery based on different grades of postoperative bladder function: (a) grade 0, (b) grade I, (c) grade II.

The remaining Forest plots compare the two techniques in terms of (d) resectable parametrial width and (e) vaginal cuff length.