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Efficacy and oncologic safety of nerve-sparing radical hysterectomy for cervical cancer: a randomized controlled trial

Journal of Gynecologic Oncology
2015년 26권 2호 p.90 ~ p.99
노주원 ( Roh Ju-Won ) - Dongguk University College of Medicine Dongguk University Ilsan Hospital Department of Obstetrics and Gynecology

이동옥 ( Lee Dong-Ock ) - Center for Uterine Cancer
서동훈 ( Suh Dong-Hoon ) - Seoul National University Bundang Hospital Department of Obstetrics and Gynecology
임명철 ( Lim Myong-Cheol ) - Center for Uterine Cancer
서상수 ( Seo Sang-Soo ) - Center for Uterine Cancer
정진수 ( Chung Jin-Soo ) - National Cancer Center Center for Prostate Cancer Department of Urology
 ( Lee Sun ) - Kyung Hee University School of Medicine Department of Pathology
박상윤 ( Park Sang-Yoon ) - National Cancer Center Center for Uterine Cancer

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.

Conclusion: NSRH appears to be effective in preserving bladder function without sacrificing oncologic safety.

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