title: Class III nerve-sparing radical hysterectomy versus standard class III radical hysterectomy: an observational study.
abstract: BACKGROUND
  The purpose of this observational study was to evaluate disease-free survival, overall survival, local recurrence rate, and morbidities in patients submitted to class III nerve-sparing radical hysterectomy (NSRH) compared with standard radical hysterectomy (RH) in cervical cancer (CC). This was a comparative study in the context of multimodal therapies.
  
  
  METHODS
  We investigated patients with CC admitted to the National Cancer Institute of Milan between January 4, 2001, and September 29, 2009, treated with NSRH. We compared patients operated with RH between March 20, 1980, and December 28, 1995. A total of 496 patients were enrolled. The median follow-up was 93 months (42 and 159 months for the NSRH and RH groups, respectively).
  
  
  RESULTS
  The overall number of relapses was 30 out of 185 and 60 out of 311 for NSRH and RH, respectively. Five-year disease-free survival estimate was 78.9% (95% confidence interval [CI] 72.0-85.7) in NSRH and 79.8% (95% CI 75.3-84.3) in RH (P=0.519). Five-year overall survival estimate was 90.8% (95% CI 85.9-95.6) in NSRH and 84.1% (95% CI 8.0-88.3) in RH (P=0.192). Rates of postoperative serious complications were 9.7% and 19.6% for NSRH and RH, respectively (P=0.004). Positive pelvic lymph node and vagina status were significant (P<0.01) independent predictors by multivariable analyses.
  
  
  CONCLUSIONS
  The oncologic results were comparable between NSRH and conventional class III RH in the context of two multimodal treatments. Bladder function and postoperative complications rate are improved by nerve-sparing technique. The nerve-sparing technique should be considered in all CC patients addressed to surgery because it improves functional outcome and preserves radicality without compromising overall survival.
authors.affiliation: Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy. antonino.ditto@istitutotumori.mi.it
authors.forename: Antonino
authors.initials: A
authors.lastname: Ditto
authors.forename: Fabio
authors.initials: F
authors.lastname: Martinelli
authors.forename: Flavia
authors.initials: F
authors.lastname: Mattana
authors.forename: Claudio
authors.initials: C
authors.lastname: Reato
authors.forename: Eugenio
authors.initials: E
authors.lastname: Solima
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Carcangiu
authors.forename: Edward
authors.initials: E
authors.lastname: Haeusler
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
authors.forename: Francesco
authors.initials: F
authors.lastname: Raspagliesi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008499:Medical Records; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis / Q000294:innervation* / Q000601:surgery; D011183:Postoperative Complications; D011379:Prognosis; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult