Department of Gynecologic Oncology, IRCCS Istituto Nazionale Tumori, Milan, Italy.
Gynecol Oncol. 2010 Nov;119(2):192-7. doi: 10.1016/j.ygyno.2010.07.030. Epub 2010 Aug 16.
To analyze local recurrence rate (LRR), morbidities and oncologic outcome of class III nerve-sparing radical hysterectomy.
170 consecutive class III NSRH cases were performed. Nineteen patients were addressed directly to surgery whilst neoadjuvant chemotherapy was administered in 151 patients. The majority of patients had SCC (75%). The median follow-up was 31 months.
The mean age was 50 [27-78] years. Mean post-operative hospital stay was 7 [3-16] days. 2 intraoperative complications occurred. Operating time and blood loss was similar to the state-of-the-art of conventional radical hysterectomy. Overall G3-4 complication rate was 8.2 % (14/170). Early G3-4 complication rate was 3.5% (6/170). Late G3-4 complication rate was: 4.7%. (8/170). Positive pelvic nodes were noted in 31 patients (18.2%). Vagina and parametrial involvement were present in 38 (22%) and 27 (15.8%) patients, respectively. LRR was 10% (17/170). The sites of relapse were: 12 pelvic, 5 vaginal. There were 9 patients DOD. The 2-year and 5-year DFS rates were 89% and 81%, respectively. Univariate and multivariate analysis identified vagina involvement and postoperative treatment as significant prognostic factors.
The oncologic results of NSRH were similar to the state-of-the-art of conventional radical hysterectomy. Two years DFS in relation to FIGO stage of disease was 92.3, 89.2 and 86.1 % respectively for IB1, IB2, IIB comparable to literature data. The early and late complications rate related to autonomic injury was significantly lower. The nerve-sparing technique should be considered in all cervical cancer patients addressed to surgery.
分析 III 类保留神经的根治性子宫切除术的局部复发率（LRR）、发病率和肿瘤学结果。
对 170 例连续的 III 类 NSRH 病例进行了分析。19 例患者直接手术，151 例患者接受新辅助化疗。大多数患者为 SCC（75%）。中位随访时间为 31 个月。
平均年龄为 50 [27-78] 岁。平均术后住院时间为 7 [3-16] 天。术中发生 2 例并发症。手术时间和出血量与传统根治性子宫切除术相当。总共有 8.2%（170/170）的患者发生 G3-4 级并发症。早期 G3-4 级并发症发生率为 3.5%（170/170）。晚期 G3-4 级并发症发生率为 4.7%（170/170）。31 例（18.2%）患者盆腔淋巴结阳性。38 例（22%）和 27 例（15.8%）患者阴道和宫旁受累，LRR 为 10%（170/170）。复发部位：12 例盆腔，5 例阴道。有 9 例患者死亡。2 年和 5 年 DFS 率分别为 89%和 81%。单因素和多因素分析表明，阴道受累和术后治疗是显著的预后因素。
NSRH 的肿瘤学结果与传统根治性子宫切除术相当。与疾病 FIGO 分期相关的 2 年 DFS 分别为 IB1、IB2、IIB 的 92.3%、89.2%和 86.1%，与文献数据相当。与自主神经损伤相关的早期和晚期并发症发生率显著降低。神经保留技术应考虑用于所有接受手术治疗的宫颈癌患者。
