Meta-analysis Of Nerve-sparing Or Conventional Radical Hysterectomy For Early-stage Cervical Cancer

Objective:In the surgical treatment of early-stage cervical cancer,the quality of life got worse due to pelvic nerve excision.The decrease of postoperative quality of life was manifested in bladder function,rectal function and sexual function.In contrast,nerve-sparing radical hysterectomy compensates for these deficiencies,but there is controversy over its radical and clinical outcome.This study conducted an evidence-based medical analysis of the two surgical methods to compare the differences in efficacy,safety and prognosis.Methods:The clinical data was retrieved from Pub Med/Medline,Springer link,The Cochrane Library,EMbase,CNKI and other databases.The selected studies were published between 2000 and 2021 to compare nerve-sparing radical hysterectomy for cervical cancer with conventional radical hysterectomy.The studies were strictly screened according to the inclusion and exclusion criteria,and the quality of the included studies was scored by referring to the Newcastle-Ottawa Scale（NOS）,and the bias risk assessment tool recommended by Cochrane Manual.Firstly,the basic information and data of the studies were extracted,and then the data were summarized.After that,Review Manager 5.4 software was used for meta-analysis,while the appropriate effect model was chosen according to the heterogeneity.Result:A total of 51 clinical studies were included,including 36 Chinese literatures and 15 English literatures.Meta-analysis results showed that there was no statistically significant difference in the basic characteristics（age and BMI）of patients in the NSRH group and the CRH group.The studies of different surgical approaches（laparoscopy/laparotomy）were counted as subgroups and compared respectively.Items with statistically significant differences: Compared with the traditional surgery group,the operation time of NSRH was longer in both laparoscopic and open surgery.In both laparoscopic and open surgery,the NSRH group had shorter hospital stay（P<0.05）and fewer days of indwelling catheter（P<0.05）,the first postoperative exhaust and defecation were earlier（P<0.05）.The laparoscopic NSRH group had a lower incidence of urinary incontinence after catheter removal（P<0.05）.Laparoscopic NSRH group had a lower incidence of urinary retention after catheter extraction（P<0.05）.The incidence of perioperative lymphocysts was lower in the NSRH group under laparoscopy（P<0.05）.In both laparoscopic and open surgery,the residual urine returning to normal level faster in the NSRH group（P<0.05）.The laparoscopic NSRH group had shorter paratropical tissue resection width（P<0.05）.The NSRH group had fewer constipation after the perioperative period（P=0.03<0.05）.The FSFI score was higher in the laparoscopic NSRH group（P<0.05）.Those differences were statistically significant.Items without statistically significant differences: There was no significant difference in operative blood loss between NSRH and CRH in laparoscopic（P=0.83>0.05）or open surgery（P=0.26>0.05）.There was no significant difference between NSRH and CRH in the number of dissected lymph nodes（laparoscopic P=0.10>0.05）（open surgery P=0.24>0.05）.There was no significant difference in length of vaginal wall resection between NSRH and CRH（laparoscopic P=0.21>0.05）（P=0.27>0.05）.There was no significant difference in perioperative urinary incontinence between laparoscopic NSRH and CRH（P=0.23>0.05）.For clinical outcome,there was no significant difference in 1-year recurrence rate between NSRH and CRH under laparoscopy（P=0.66>0.05）.There was no significant difference in 1-year overall survival（OS）between NSRH and CRH under laparoscopy（P=0.41>0.05）.There was no significant difference in 2-year recurrence free survival（RFS）between NRSH and CRH in both laparoscopy（P=0.68>0.05）and open surgery（P=0.24>0.05）.There was no significant difference in 3-year RFS between NRSH and CRH in laparoscopy（P=0.96>0.05）.There was no significant difference in 5-year RFS between NRSH and CRH in both laparoscopy（P=0.97>0.05）and open surgery（P=0.11>0.05）.For OS,there was no significant difference in 2-year OS between NRSH and CRH in both laparoscopy（P=0.53>0.05）and open surgery（P=0.37>0.05）.There was no significant difference in 3-year OS between NRSH and CRH in both laparoscopy（P=0.47>0.05）and open surgery（P=0.09>0.05）.There was no significant difference in 5-year OS between NRSH and CRH in open surgery（P=0.88>0.05）.Conclusion:1.The NSRH group was significantly better than the CRH group in terms of the length of hospital stay,duration of indwelling catheter after operation,time of first defecation,retention and incontinence after catheter extraction,the recovery of residual urine after catheter extraction and the appearance of perioperative lymphocysts.However,there were no significant differences in blood loss between the two groups.2.In terms of radical surgery,there were no significant difference in the number of lymph nodes and length of vaginal wall resection between the NSRH group and the CRH group.The excision length of parauterine tissue could be shorter in the NSRH group.3.Compared with the CRH group,the NSRH group showed better recovery of bladder function and lower incidence of urinary incontinence.Besides,the incidence of constipation was lower,and the FSFI score was higher in NSRH group after perioperative period.4.There was no significant difference in 1,2,3 and 5-year recurrence free survival rate and 1,2,3 and 5-year overall survival rate between the NSRH group and the CRH group.5.On the premise of mastering surgical indications,completing preoperative examination and proficiency in operation,NSRH can be safer and more effective in the treatment of early-stage cervical cancer compared with CRH,so that patients can obtain a better quality of life.