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.