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Nerve-Sparing Versus Conventional Laparoscopic Radical Hysterectomy: A Minimum 12 Months’ Follow-up Study

Bogani, Giorgio MD; Cromi, Antonella PhD; Uccella, Stefano MD; Serati, Maurizio MD; Casarin, Jvan MD; Pinelli, Ciro MD; Nardelli, Federica MD; Ghezzi, Fabio MD

International Journal of Gynecological Cancer: May 2014 - Volume 24 - Issue 4 - p 787–793
doi: 10.1097/IGC.0000000000000110
Surgeons Corner

Objective: The objective of this study was to determinate whether the introduction of nerve-sparing (NS) procedure influences surgical and survival outcomes of cervical cancer patients undergoing laparoscopic radical hysterectomy (LRH).

Methods: Data of consecutive patients undergoing minimally invasive radical with or without NS surgery for cervical cancer were enrolled in the study.

Results: Sixty-three patients (66%) who had LRH were compared with 33 women (34%) undergoing NS-LRH. Among the NS group, 19 patients (57.6%) had surgery via minilaparoscopy (using 3-mm instruments). Baseline characteristics were similar between groups. Patients undergoing NS-LRH had shorter operative time (210 vs 257 minutes; P = 0.005) and higher number of pelvic lymph nodes yielded (29 [26–38] vs 22 [8–49]; P < 0.001) than patient in the control group. No differences in blood loss, complications, and parametrial width were observed. Patients were catheterized with an indwelling Foley catheter for a median of 3.5 days (2–7 days) and 5.5 days (4–7 days) in NS and non-NS groups, respectively (P = 0.01). Voiding dysfunctions occurred in 1 patient (3%) and 12 patients (19%) who underwent NS-LRH and standard LRH, respectively (P = 0.03). No differences in 3-year disease-free survival (P = 0.72) and overall survival (P = 0.71) were recorded.

Conclusions: The beneficial effects (in terms of operative time and number of nodes harvested) of NS-LRH are likely determined by the expertise of the surgeon because NS approach was introduced after having acquired adequate background in conventional LRH. Our data show that in experienced hands NS-LRH is safe and feasible. Moreover, NS technique reduces catheterization time and the rate of postoperative urinary dysfunction.

Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.

Address correspondence and reprint requests to Giorgio Bogani, MD, Department of Obstetrics and Gynecology, University of Insubria, Piazza Biroldi, 1-Varese, 21100, Italy. E-mail: giorgiobogani@yahoo.it.

The study was conducted in Varese, Italy.

Presented at the 18th International Meeting of the European Society of Gynecological Oncology, Liverpool, UK, 2013.

No funding sources supported this investigation.

The authors declare no conflicts of interest.

Received December 24, 2013

Accepted January 19, 2014

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.