title: Clinical efficacy and safety of nerve-sparing radical hysterectomy for cervical cancer: a systematic review and meta-analysis.
abstract: Nerve-sparing radical hysterectomy (NSRH) may be associated with lower postoperative morbidity than radical hysterectomy (RH). We aimed to compare the clinical efficacy and safety of abdominal or laparoscopic NSRH and RH for treating cervical cancer through systematic review and meta-analysis.
  
  
  METHODS
  PubMed, EMBASE, The Cochrane Library and the Chinese National Knowledge Infrastructure databases were systematically searched for all relevant studies. Data were abstracted independently by two reviewers. A meta-analysis was performed to compare intra- and postoperative outcomes for the two techniques.
  
  
  RESULTS
  A total of 17 clinical trials were identified. Meta-analysis showed that although operating time was significantly longer for abdominal or laparoscopic NSRH than for RH, NSRH based on laparotomy or laparoscopy proved more effective for postoperative recovery of bladder function. NSRH was also associated with lower bladder dysfunction morbidity and fewer postoperative complications. Two abdominal trials and one laparoscopic study further suggested that NSRH was associated with shorter time to recovery of anal/rectal function. In contrast, RH and NSRH based on laparotomy or laparoscopy were similar in terms of extent of resection, recurrence rate, survival rate, blood loss and frequency of intraoperative complications. The meta-analysis showed that abdominal NSRH was not significantly different from RH in length of hospital stay, while one trial suggested that length of hospital stay was shorter after laparoscopic NSRH than after the corresponding RH.
  
  
  CONCLUSIONS
  NSRH may be a reliable technique for treating early cervical cancer. Available evidence suggests that it is better than RH for postoperative recovery of pelvic organ function and postoperative morbidity, while the two techniques involve similar clinical safety and extent of resection. These results should be considered preliminary since they are based on a relatively small number of controlled trials, most of which were non-randomized. The findings should be verified in larger, well-designed studies.
authors.affiliation: Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guang Xi Medical University, Nanning, People's Republic of China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Long
authors.affiliation: Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guang Xi Medical University, Nanning, People's Republic of China.
authors.forename: De-Sheng
authors.initials: DS
authors.lastname: Yao
authors.affiliation: Department of Gynecologic Oncology, Affiliated Tumor Hospital of Guang Xi Medical University, Nanning, People's Republic of China.
authors.forename: Xin-Wei
authors.initials: XW
authors.lastname: Pan
authors.affiliation: Department of Gynecology, Third Affiliated Hospital of Guang Xi Medical University, Nanning, People's Republic of China.
authors.forename: Ting-Yu
authors.initials: TY
authors.lastname: Ou
mesh_terms: D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods*; D009420:Nervous System / Q000503:physiopathology; D059351:Organ Sparing Treatments / Q000009:adverse effects* / Q000379:methods*; D012449:Safety; D002583:Uterine Cervical Neoplasms / Q000503:physiopathology / Q000601:surgery*
references.citation: Anticancer Res. 2012 Feb;32(2):581-8
references.pmid: 22287748
references.citation: Int J Gynecol Cancer. 2007 Sep-Oct;17(5):1075-82
references.pmid: 17386041
references.citation: Int J Gynecol Cancer. 2001 May-Jun;11(3):180-6
references.pmid: 11437922
references.citation: BJOG. 2004 May;111(5):456-62
references.pmid: 15104610
references.citation: Surg Endosc. 2013 Apr;27(4):1237-42
references.pmid: 23076460
references.citation: Int J Gynecol Cancer. 2009 Jan;19(1):39-45
references.pmid: 19258939
references.citation: Zhonghua Fu Chan Ke Za Zhi. 2009 May;44(5):359-63
references.pmid: 19573312
references.citation: Surg Innov. 2013 Oct;20(5):493-501
references.pmid: 23339145
references.citation: Am J Obstet Gynecol. 1998 May;178(5):971-6
references.pmid: 9609569
references.citation: Gynecol Oncol. 2010 Mar;116(3):502-5
references.pmid: 20004957
references.citation: Int J Gynecol Cancer. 2011 Feb;21(2):391-6
references.pmid: 21270622
references.citation: Gynecol Oncol. 2007 Oct;107(1):4-13
references.pmid: 17905140
references.citation: Taiwan J Obstet Gynecol. 2012 Mar;51(1):55-9
references.pmid: 22482969
references.citation: Zhonghua Fu Chan Ke Za Zhi. 2008 Aug;43(8):606-10
references.pmid: 19087497
references.citation: Int J Gynecol Cancer. 2008 Jul-Aug;18(4):868-75
references.pmid: 17892457
references.citation: Zhonghua Zhong Liu Za Zhi. 2011 Jan;33(1):53-7
references.pmid: 21575466
references.citation: Gynecol Oncol. 2010 Nov;119(2):202-7
references.pmid: 20673971
references.citation: N Engl J Med. 1999 May 6;340(18):1383-9
references.pmid: 10228188
references.citation: Gynecol Oncol. 2010 Mar;116(3):506-11
references.pmid: 19906412
references.citation: Int J Gynecol Cancer. 2010 Jul;20(5):905-9
references.pmid: 20606542
references.citation: Int J Gynecol Cancer. 2010 Oct;20(7):1274-83
references.pmid: 21495251
references.citation: Int J Gynecol Cancer. 2008 May-Jun;18(3):576-83
references.pmid: 17692083
references.citation: Zhonghua Fu Chan Ke Za Zhi. 2009 Aug;44(8):605-9
references.pmid: 20003790
references.citation: Int J Gynecol Cancer. 2011 Feb;21(2):355-62
references.pmid: 21270616
references.citation: Zhonghua Zhong Liu Za Zhi. 2009 Aug;31(8):607-11
references.pmid: 20021949
references.citation: Ann Surg Oncol. 2011 Nov;18(12):3469-78
references.pmid: 21556949
references.citation: Gynecol Oncol. 2000 Apr;77(1):155-63
references.pmid: 10739705
references.citation: Int J Gynecol Cancer. 2005 Mar-Apr;15(2):389-97
references.pmid: 15823132
references.citation: Gynecol Oncol. 2006 Aug;102(2):256-62
references.pmid: 16445968
references.citation: J Minim Invasive Gynecol. 2010 Jan-Feb;17(1):37-41
references.pmid: 20129330
references.citation: Crit Rev Oncol Hematol. 2003 Dec;48(3):287-93
references.pmid: 14693341
references.citation: Obstet Gynecol. 2007 Jul;110(1):96-102
references.pmid: 17601902
references.citation: J Laparoendosc Adv Surg Tech A. 2010 Dec;20(10):813-9
references.pmid: 21091224
references.citation: Int J Gynecol Cancer. 2006 Jul-Aug;16(4):1705-12
references.pmid: 16884390
references.citation: Crit Rev Oncol Hematol. 2003 Dec;48(3):271-9
references.pmid: 14693339
references.citation: Int J Gynecol Cancer. 2013 Jul;23(6):1145-9
references.pmid: 23748178
references.citation: Int J Med Robot. 2012 Jun;8(2):206-9
references.pmid: 22374890
references.citation: J Minim Invasive Gynecol. 2007 Nov-Dec;14(6):682-9
references.pmid: 17980327
references.citation: Int J Gynecol Cancer. 2012 Oct;22(8):1383-8
references.pmid: 22964523
references.citation: Cancer. 2008 Nov 15;113(10 Suppl):2855-64
references.pmid: 18980204
references.citation: Int J Gynecol Cancer. 2006 Jan-Feb;16(1):369-75
references.pmid: 16445660
references.citation: Gynecol Oncol. 2012 Apr;125(1):245-51
references.pmid: 22209773