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Conventional versus nerve-sparing radical surgery for cervical cancer: a meta-analysis

Journal of Gynecologic Oncology
2015년 26권 2호 p.100 ~ p.110
김희승 ( Kim Hee-Seung ) - Seoul National University College of Medicine Department of Obstetrics and Gynecology

김기원 ( Kim Kee-Won ) - Seoul National University College of Medicine Department of Rehabilitation Medicine
유승범 ( Ryoo Seung-Bum ) - Seoul National University College of Medicine Department of Surgery
 ( Seo Joung-Hwa ) - Seoul National University Hospital Department of Anesthesiology and Pain Medicine
김상윤 ( Kim Sang-Youn ) - Seoul National University Hospital Department of Radiology
박지원 ( Park Ji-Won ) - Seoul National University College of Medicine Department of Surgery
김민아 ( Kim Min-A ) - Seoul National University College of Medicine Department of Pathology
홍경섭 ( Hong Kyoung-Sup ) - Korea Seoul National University College of Medicine Department of Internal Medicine
정창욱 ( Jeong Chang-Wook ) - Seoul National University College of Medicine Department of Urology
 ( Song Yong Sang ) - Seoul National University College of Medicine Cancer Research Institute

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.

Conclusion
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.

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SCI(E) MEDLINE 학술진흥재단(KCI) KoreaMed 대한의학회 회원 
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