Yin Sheng, Ma Si-Ning, Zhang Yu-Qin, Shi Ting-Yan, Xiang Li-Bing, Ren Yu-Lan, Zang Rong-Yu
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, China.
Department of Gynecologic Oncology, Fudan University Cancer Hospital, China.
Surg Oncol. 2018 Sep;27(3):380-386. doi: 10.1016/j.suronc.2018.05.015. Epub 2018 May 25.
An improved nerve-sparing radical hysterectomy (NSRH), which is based on the paravesico-vaginal space, has been recently introduced in a phase II, prospective clinical trial by our team. This study aims to report the surgical and oncological outcomes of this improved NSRH.
One hundred seventy-seven consecutive patients were enrolled in our study and underwent the improved NSRH. The proportion of successful catheter removal and postvoid residual urine volume (PVR) of 50 mL or less at postoperative day 7 or day 4 was used to assess surgical outcomes. The local control rate (LCR), disease free survival (DFS), and overall survival (OS) were used to assess oncological outcomes.
Postoperative 30-day complications occurred in 27/177 (15.3%) patients. The rate of successful catheter removal and PVR of 50 mL or less were 85.2% (23/27) and 66.7% (18/27) at postoperative day 7, and 73.3% (110/150) and 35.3% (53/150) at postoperative day 4. A total of 13 (7.9%) patients showed recurrence after a median follow-up time of 39.2 months (range 3.2-68.1 months). The estimated 2-year and 5-year DFS rates were 92.2% and 91.1%, respectively. Seven (4.2%) patients presented local recurrence, and five (3.0%) patients were dead at the end of the follow-up period. The estimated 5-year LCR and OS were 95.1% and 96.2%, respectively. In univariate analysis, International Federation of Gynecology and Obstetrics (FIGO) stage, lymphovascular space invasion (LVSI), and lymph node metastasis were found to be the prognostic risk factors of DFS. Patients with LVSI were associated with a worse DFS according to the multivariate analysis.
The improved NSRH in our study may provide better surgical outcomes without compromising the survival in patients with early cervical cancer.
基于膀胱阴道旁间隙的改良保留神经根治性子宫切除术（NSRH），最近已由我们团队引入一项II期前瞻性临床试验。本研究旨在报告这种改良NSRH的手术和肿瘤学结果。
177例连续患者纳入本研究并接受改良NSRH。术后第7天或第4天成功拔除导尿管的比例以及残余尿量（PVR）≤50 mL用于评估手术结果。局部控制率（LCR）、无病生存期（DFS）和总生存期（OS）用于评估肿瘤学结果。
27/177（15.3%）例患者发生术后30天并发症。术后第7天成功拔除导尿管的比例和PVR≤50 mL分别为85.2%（23/27）和66.7%（18/27），术后第4天分别为73.3%（110/150）和35.3%（53/150）。中位随访时间39.2个月（范围3.2 - 68.1个月）后，共有13例（7.9%）患者出现复发。估计2年和5年DFS率分别为92.2%和91.1%。7例（4.2%）患者出现局部复发，5例（3.0%）患者在随访期末死亡。估计5年LCR和OS分别为95.1%和96.2%。单因素分析中，国际妇产科联盟（FIGO）分期、淋巴管间隙浸润（LVSI）和淋巴结转移被发现是DFS的预后风险因素。多因素分析显示，LVSI患者的DFS较差。
我们研究中的改良NSRH可能为早期宫颈癌患者提供更好的手术结果，且不影响生存率。
