Nerve-sparing radical hysterectomy versus conventional radical hysterectomy in early-stage cervical cancer. A systematic review and meta-analysis of survival and quality of life.
OBJECTIVE
Survival after radical hysterectomy (RH) for early-stage cervical cancer is good. Hence quality of life (QOL) after treatment is an important issue. Nerve-sparing radical hysterectomy (NSRH) improves QOL by selectively sparing innervation of bladder, bowel and vagina, reducing therapy-induced morbidity. However, the oncological outcome and the functional outcome after NSRH are subjects of debate. We aim to present the best possible evidence available regarding both QOL and survival after NSRH in early-stage cervical cancer.


METHODS
Systematic review and meta-analysis on studies comparing NSRH and RH.


RESULTS
Forty-one studies were included, and 27 were used for the meta-analysis. There was no difference in 2-, 3- and 5-year overall survival: the risk ratios (RRs) were respectively 1.02 (95% CI 0.99-1.05, n=879), 1.01 (95% CI 0.95-1.08, n=1324) and 1.03 (95% CI 0.99-1.08, n=638). No difference was found in 2-, 3- and 5-year disease-free survival: RR 1.01 (95% CI 0.95-1.05, n=1175), 0.99 (95% CI 0.94-1.03, n=1130) and 1.00 (95% CI 0.95-1.06, n=933) respectively. Post-operative time to micturition was significantly shorter in the NSRH group: standardized mean difference (SMD) -0.84 (CI 95% -1.07 to -0.60).


CONCLUSIONS
NSRH can be considered safe and effective for early-stage cervical cancer since short- and long-term survival do not differ from those of conventional RH, while bladder function after NSRH is significantly less impaired.
Department of Gynaecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Electronic address: m.d.j.m.van_gent@lumc.nl.
M D J M
MD
van Gent
Department of Gynaecology, Medical Center Haaglanden-Bronovo, Lijnbaan 32, 2512 VA, The Hague, The Netherlands. Electronic address: l.romijn@mchaaglanden.nl.
L M
LM
Romijn
Department of Gynaecology, Medical Center Haaglanden-Bronovo, Lijnbaan 32, 2512 VA, The Hague, The Netherlands. Electronic address: k.van.santen@mchaaglanden.nl.
K E
KE
van Santen
Department of Gynaecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Electronic address: j.b.m.z.trimbos@lumc.nl.
J B M Z
JB
Trimbos
Department of Gynaecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Electronic address: c.d.de_kroon@lumc.nl.
C D
CD
de Kroon
D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D011788:Quality of Life; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000601:surgery*
Cervical cancer; Nerve-sparing; Quality of life; Safety; Survival