Nerve-sparing radical hysterectomy in cervical cancer: evolution of concepts.
OBJECTIVE
This paper reviews the evolution of concepts concerning the nerve-sparing radical hysterectomy (NSRH) in cervical cancer.


METHODS
Research studies published between 1991 and 2006 were reviewed.


RESULTS
Significant progress has been made in understanding the neuroanatomy and the neurophysiology of autonomic pelvic plexus. The ideal surgical management of cervical cancer patients should be tailored on the basis of prognostic factors and quality of life. Within the discussion concerning the optimal level of radicality of hysterectomy, which is still controversial, the new concept of NSRH has to be considered in order to reduce morbidity without compromising the oncological disease control. Surgical strategies have been developed to spare the autonomic functions with promising results.


CONCLUSIONS
To date, there is a growing body of data about NSRH in cervical cancer. However, there is not yet a consensus concerning to which part of uterine support ligaments a NS approach should be directed.
Raspagliesi
Francesco
F
Department of Gynecologic Oncology, Istituto Nazionale Tumori, Milan, Italy.
Ditto
Antonino
A
Hanozet
Francesco
F
Martinelli
Fabio
F
Solima
Eugenio
E
Zanaboni
Flavia
F
Kusamura
Shigeki
S
Fontanelli
Rosanna
R
D002584:Cervix Uteri / Q000294:innervation / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000639:trends; D002583:Uterine Cervical Neoplasms / Q000601:surgery*