Classical and nerve-sparing radical hysterectomy: an evaluation of the nerve trauma in cardinal ligament.
OBJECTIVE
This study evaluated histopathology and clinical outcome of autonomic nerve trauma and vessels removal within the cardinal ligament (CL) during nerve-sparing radical hysterectomy (NSRH) compared with radical hysterectomy (RH).


METHODS
25 women with FIGO stage Ib1-IIa cervical cancer underwent RH (n=13) or NSRH (n=12). Removed CLs lengths were measured. Biopsies were collected from the proximal, middle and distal segment of CLs and fixed. Different markers were used for immunohistochemisty analysis: tyrosine hydroxylase for sympathetic nerves; vasoactive intestinal polypeptide for parasympathetic nerves; CD34 for blood vessels; and D2-40 for lymphatic vessels. The volume density (Vv), a parameter of biological stereology, was used to quantitatively measure CL components, while post-operative functions, such as defecation, micturition and two-year disease free survival in RH and NSRH groups were compared.


RESULTS
The nerves mainly existed in the middle and distal segments of CLs. The Vv was greater in RH compared with NSRH for both sympathetic and parasympathetic nerve markers (P<0.05), while the Vv of blood and lymphatic vessels were same in the two groups. Average time to achieve residual urine≤50ml and first defecation were shorter in NSRH than in RH (P<0.05).


CONCLUSIONS
Less autonomic nerves within CL are transected in NSRH than in RH, while blood/lymphatic vessels are efficiently removed in both treatments. Compared to RH, NSRH decreases iatrogenic injury, which leads to reduced post-operative co-morbidities, with ensure the same radicality.
Department of Obstetrics and Gynecology, Southern Medical University, Guangzhou, People's Republic of China.
Chunlin
C
Chen
Weili
W
Li
Fengjuan
F
Li
Ping
P
Liu
Jing
J
Zhou
Lin
L
Lu
Guidong
G
Su
Xiangzhao
X
Li
Yu
Y
Guo
Lei
L
Huang
D000328:Adult; D017776:Autonomic Pathways / Q000293:injuries* / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D008022:Ligaments / Q000098:blood supply / Q000294:innervation / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000601:surgery*; D014599:Uterus / Q000098:blood supply / Q000294:innervation / Q000601:surgery*
D015415:Biomarkers