Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China.
Am J Clin Oncol. 2019 Oct;42(10):783-788. doi: 10.1097/COC.0000000000000593.
The purpose of this retrospective study was to compare the surgical, urinary, and survival outcomes between nerve-sparing radical hysterectomy (NSRH) and traditional radical hysterectomy (TRH) for stage IB cervical cancer, in which all the primary procedures were performed by a single physician.
Patients with cervical cancer of International Federation of Gynecology and Obstetrics (FIGO) stage IB were included if they received radical hysterectomy of class III or type C in 1 center between February 2001 and November 2015. The epidemiological, clinicopathologic, surgical, and urinary data were collected and compared between the NSRH and TRH groups. The follow-up period ended in December 2016.
A total of 406 patients were identified, including 111 (27.3%) in the TRH group and 295 (72.7%) in the NSRH group. Most epidemiological and clinicopathologic characteristics were balanced between the 2 groups. The NSRH and TRH groups had similar mean operating times and comparable short-term postoperative complications, but NSRH had less mean estimated blood loss and a shorter mean postoperative stay (all P <0.001). Within 12 months from surgeries, patients in the NSRH group had less residual urine and fewer urinary dysfunctions. For the 371 patients with definite survival outcomes, in the multivariate analysis, both overall survival (hazard ratio=1.79, 95% confidence interval: 0.64-5.02) and disease-free survival (hazard ratio=1.50, 95% confidence interval: 0.72-3.11, P=0.280) of the NSRH group were similar to those of the TRH group.
NSRH for stage IB cervical cancer patients had better urinary outcomes than TRH without sacrificing the safety and survival benefits.
本回顾性研究旨在比较单名医生施行的神经保留根治性子宫切除术（NSRH）与传统根治性子宫切除术（TRH）治疗国际妇产科联盟（FIGO）分期 IB 期宫颈癌的手术、尿控和生存结局。
本研究纳入 2001 年 2 月至 2015 年 11 月期间在 1 家中心接受 III 级或 C 型宫颈癌根治性子宫切除术的 FIGO 分期 IB 期宫颈癌患者。收集并比较 NSRH 组和 TRH 组的流行病学、临床病理、手术和尿控数据。随访于 2016 年 12 月结束。
共纳入 406 例患者，其中 TRH 组 111 例（27.3%），NSRH 组 295 例（72.7%）。两组患者的大多数流行病学和临床病理特征均均衡。NSRH 组和 TRH 组的手术时间相近，短期术后并发症相当，但 NSRH 组术中估计出血量更少，术后住院时间更短（均 P<0.001）。术后 12 个月内，NSRH 组患者的残余尿量更少，尿控功能障碍更少。在有明确生存结局的 371 例患者中，多因素分析显示 NSRH 组的总生存（风险比=1.79，95%置信区间：0.64-5.02）和无疾病生存（风险比=1.50，95%置信区间：0.72-3.11，P=0.280）与 TRH 组相似。
对于 FIGO 分期 IB 期宫颈癌患者，NSRH 不仅可以改善尿控，而且不影响手术安全性和生存获益。
