title: Efficacy and oncologic safety of nerve-sparing radical hysterectomy for cervical cancer: a randomized controlled trial.
abstract: OBJECTIVE
  A prospective, randomized controlled trial was conducted to evaluate the efficacy of nerve-sparing radical hysterectomy (NSRH) in preserving bladder function and its oncologic safety in the treatment of cervical cancer.
  
  
  METHODS
  From March 2003 to November 2005, 92 patients with cervical cancer stage IA2 to IIA were randomly assigned for surgical treatment with conventional radical hysterectomy (CRH) or NSRH, and 86 patients finally included in the analysis. Adequacy of nerve sparing, radicality, bladder function, and oncologic safety were assessed by quantifying the nerve fibers in the paracervix, measuring the extent of paracervix and harvested lymph nodes (LNs), urodynamic study (UDS) with International Prostate Symptom Score (IPSS), and 10-year disease-free survival (DFS), respectively.
  
  
  RESULTS
  There were no differences in clinicopathologic characteristics between two groups. The median number of nerve fiber was 12 (range, 6 to 21) and 30 (range, 17 to 45) in the NSRH and CRH, respectively (p<0.001). The extent of resected paracervix and number of LNs were not different between the two groups. Volume of residual urine and bladder compliance were significantly deteriorated at 12 months after CRH. On the contrary, all parameters of UDS were recovered no later than 3 months after NSRH. Evaluation of the IPSS showed that the frequency of long-term urinary symptom was higher in CRH than in the NSRH group. The median duration before the postvoid residual urine volume became less than 50 mL was 11 days (range, 7 to 26 days) in NSRH group and was 18 days (range, 10 to 85 days) in CRH group (p<0.001). No significant difference was observed in the 10-year DFS between two groups.
  
  
  CONCLUSIONS
  NSRH appears to be effective in preserving bladder function without sacrificing oncologic safety.
authors: Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.
authors: Ju Won
authors: JW
authors: Roh
authors: Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
authors: Dong Ock
authors: DO
authors: Lee
authors: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors: Dong Hoon
authors: http://orcid.org/0000-0002-4312-966X
authors: DH
authors: Suh
authors: Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
authors: Myong Cheol
authors: MC
authors: Lim
authors: Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
authors: Sang Soo
authors: SS
authors: Seo
authors: Department of Urology, Center for Prostate Cancer, National Cancer Center, Goyang, Korea.
authors: Jinsoo
authors: J
authors: Chung
authors: Department of Pathology, Kyung Hee University School of Medicine, Seoul, Korea.
authors: Sun
authors: S
authors: Lee
authors: Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea. parksang@ncc.re.kr.
authors: Sang Yoon
authors: SY
authors: Park
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D018196:Carcinoma, Adenosquamous / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000379:methods; D010388:Pelvis / Q000294:innervation* / Q000601:surgery; D020127:Recovery of Function; D016019:Survival Analysis; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation* / Q000502:physiology / Q000601:surgery; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014599:Uterus / Q000294:innervation* / Q000601:surgery
keywords: Disease-Free Survival; Hysterectomy; Urinary Bladder, Neurogenic; Uterine Cervical Neoplasms