Introducing nerve-sparing approach during minimally invasive radical hysterectomy for locally-advanced cervical cancer: a multi-institutional experience

Publication date: Available online 7 September 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Francesco Raspagliesi, Giorgio Bogani, Arsenio Spinillo, Antonino Ditto, Stefano Bogliolo, Jvan Casarin, Umberto Leone Roberti Maggiore, Fabio Martinelli, Mauro Signorelli, Barbara Gardella, Valentina Chiappa, Cono Scaffa, Simone Ferrero, Antonella Cromi, Domenica Lorusso, Fabio Ghezzi
ObjectiveTo evaluate the impact of nerve-sparing (NS) approach on outcomes of patients undergoing minimally invasive radical hysterectomy (MRH) for locally advanced stage cervical cancer (LACC).MethodsData of consecutive patients undergoing minimally invasive surgery for LACC were retrospectively retrieved in a multi-institutional setting from 2009 to 2016. All patients included had minimally invasive class III radical hysterectomy (MRH or NS-MRH). Propensity matching algorithm was used to decrease possible allocation bias when comparing outcomes between groups.ResultsOverall, 83 patients were included. The prevalence of patients undergoing NS approach increased aver the study period (from 7% in the year 2009-2010 to 97% in the year 2015-2016; p-for-trend<.001). NS-MRH and MRH were performed in 47 (57%) and 36 (43%) patients, respectively. After the application the propensity-matching algorithm, we compared 35 patients' pair (total 70 patients). Postoperative complications rate was similar between groups. Patients undergoing NS-LRH experienced shorter hospital stay than patients undergoing LRH (3.6 vs. 5.0 days). 60-day pelvic floor dysfunction rates, including voiding, fecal and sexual alterations, were lower in the NS group in comparison to control group (p=.02). Five-year disease-free (p=.77) and overall (p=.36) survivals were similar comparing NS-MRH with MRH.ConclusionsThe implementation of NS approach in the setting of LACC improves patients' outcomes, minimizing pelvic dysfunction rates. NS approach has not detrimental effects on survival outcomes.



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