title: Conventional versus nerve-sparing radical surgery for cervical cancer: a meta-analysis.
abstract: OBJECTIVE
  Although nerve-sparing radical surgery (NSRS) is an emerging technique for reducing surgery-related dysfunctions, its efficacy is controversial in patients with cervical cancer. Thus, we performed a meta-analysis to compare clinical outcomes, and urinary, anorectal, and sexual dysfunctions between conventional radical surgery (CRS) and NSRS.
  
  
  METHODS
  After searching PubMed, Embase, and the Cochrane Library, two randomized controlled trials, seven prospective and eleven retrospective cohort studies were included with 2,253 patients from January 2000 to February 2014. We performed crude analyses and then conducted subgroup analyses according to study design, quality of study, surgical approach, radicality, and adjustment for potential confounding factors.
  
  
  RESULTS
  Crude analyses showed decreases in blood loss, hospital stay, frequency of intraoperative complications, length of the resected vagina, duration of postoperative catheterization (DPC), urinary frequency, and abnormal sensation in NSRS, whereas there were no significant differences in other clinical parameters and dysfunctions between CRS and NSRS. In subgroup analyses, operative time was longer (standardized difference in means, 0.948; 95% confidence interval [CI], 0.642 to 1.253), while intraoperative complications were less common (odds ratio, 0.147; 95% CI, 0.035 to 0.621) in NSRS. Furthermore, subgroup analyses showed that DPC was shorter, urinary incontinence or frequency, and constipation were less frequent in NSRS without adverse effects on survival and sexual functions.
  
  
  CONCLUSIONS
  NSRS may not affect prognosis and sexual dysfunctions in patients with cervical cancer, whereas it may decrease intraoperative complications, and urinary and anorectal dysfunctions despite long operative time and short length of the resected vagina when compared with CRS.
authors: Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors: Hee Seung
authors: HS
authors: Kim
authors: Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors: Keewon
authors: K
authors: Kim
authors: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors: Seung Bum
authors: SB
authors: Ryoo
authors: Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors: Joung Hwa
authors: JH
authors: Seo
authors: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
authors: Sang Youn
authors: SY
authors: Kim
authors: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors: Ji Won
authors: JW
authors: Park
authors: Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.
authors: Min A
authors: MA
authors: Kim
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors: Kyoung Sup
authors: KS
authors: Hong
authors: Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
authors: Chang Wook
authors: CW
authors: Jeong
authors: Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.; Major in Biomodulation, World Class University, Seoul National University, Seoul, Korea. yssong@snu.ac.kr.
authors: Yong Sang
authors: YS
authors: Song
mesh_terms: D003248:Constipation / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D007431:Intraoperative Complications / Q000453:epidemiology; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000379:methods; D010388:Pelvis / Q000294:innervation* / Q000601:surgery; D012007:Rectum / Q000294:innervation* / Q000601:surgery; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology / Q000209:etiology; D001743:Urinary Bladder / Q000294:innervation* / Q000601:surgery; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000601:surgery*; D014599:Uterus / Q000294:innervation / Q000601:surgery; D014621:Vagina / Q000294:innervation / Q000601:surgery
keywords: Hysterectomy; Intraoperative Complications; Meta-Analysis; Radical Surgery; Urinary Retention; Uterine Cervical Neoplasms