Modification Of Nerve-Sparing Radical Hysterectomy In Cerical Cancer And Postoperative Functional Assessment

Purpose:The aim of this study is to establish the nerve plane-sparing radical hysterectomy (NPSRH), a modified technique of nerve sparing radical hysterectomy, and evaluate it’s safety and effectiveness in cervical cancer patients, by comparing with conventional radical hysterectomy.Methods:From January2008to November2011, the nerve plane-sparing radical hysterectomy procedure was established and performed for73patients with International Federation of Gynecology and Obstetrics stage IB to IIA cervical cancer. The autonomic nerve-plane structures were integrally preserved during this procedure. The first16patients (From September2006to December2007) was enrolled as group1and underwent Nerve-sparing radical hysterectom. In this procedure, the detailed autonomic nerve structure were identified and separated by meticulous dissection. The patient’s clinicopathologic characteristics, surgical parameters were compared between the two groups. From January2008to November2011,140patients with parameters matched were selected randomly as group2. These patients underwent Conventional radical hysterectomy. Median duration of catheterization and multiple parameters fousing on three main areas of late morbidity:bladder, sexual and anorectal functions were assessed between the two groups.Results:Neither surgery related injury nor pathological positive margins were reported in NPSRH group. The mean surgical duration in NPSRH group and group1(nerve sparing radical hysterectomy) were260+52.5minutes and335+21.9minutes (P<0.01). Comparing with group2(242+41minutes), the mean surgical duration in NPSRH group was longer (P<0.05). Duration of catheterization in NPSRH group and group2were9.52days and16.17days (P<0.01). The long term quality of life was assessed between the NPSRH group and group2. Incomplete voiding in the2groups were14.3%and46.4%(P<0.01), constipation in the2groups were10.0%and21.4%(P=0.040), and tenesmus in the two groups were5.7%and21.4%(P=0.007). Little changes were observed in any of4parameters of sexual dysfunctions (P>0.05).Conclusions:NPSRH is a comparable safe and effective simplified modification of nerve-sparing radical hysterectomy. NPSRH can enhance the rate of rescovery in postoperative bladder function and to some extent, it is prior to Conventional radical hysterectomy in improving late mobidity of bladder and anorectal dysfunction.