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Oncological Outcomes of Nerve-Sparing Radical Hysterectomy for Cervical Cancer: A Systematic Review

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to review the oncologic outcomes of nerve-sparing radical hysterectomy (NSRH) in cervical cancer and to compare them with those of standard conventional radical hysterectomy (CRH).

Methods

A search of the MEDLINE (Ovid), EMBASE (Ovid), and Cochrane Central Register of Controlled Trials (CENTRAL) databases for studies published to March 3, 2014 was performed using the search term “nerve sparing or radical hysterectomy and cervical cancer.” The main outcome measure was the recurrence rate after NSRH. The hazard ratio for recurrence was used to compare NSRH and CRH.

Results

A total of 21 studies reported data on oncologic outcomes of NSRH. The recurrence rate after NSRH was reported to be 0 to 19.6 %. Of the 21 studies, 10 comparing outcomes between NSRH and CRH were assessed for their eligibility to be included in a meta-analysis. However, the scarcity and heterogeneity of effect estimates in these comparison trials precluded performance of a meta-analysis.

Conclusions

The results showed that the evidence addressing the oncologic safety of NSRH over that of CRH in cervical cancer is neither adequate nor statistically relevant. A properly designed, prospective randomized noninferiority trial is needed to assess the oncologic outcomes of NSRH before this surgical approach is adopted as the standard of care for patients with tumors that have unfavorable prognostic features. Until then, NSRH should be considered primarily for patients with small tumors due to the very low risk of parametrial and lymph node involvement, with maximum benefit conferred to the patient from autonomic nerve preservation without any requirement for adjuvant treatment.

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Acknowledgments

This work was supported by the grant from the Ministry of Health of the Czech Republic (RVO VFN64165), and by Charles University in Prague (UNCE 204024 and PRVOUK-P27/LF1/1).

Conflict of interest

There is no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey

    Derman Basaran MD

  2. Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic

    Ladislav Dusek PhD & Ondrej Majek PhD

  3. Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine Charles University in Prague, General University Hospital in Prague, Prague 2, Czech Republic

    David Cibula MD, PhD

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  1. Derman Basaran MD
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  2. Ladislav Dusek PhD
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  4. David Cibula MD, PhD
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Correspondence to Derman Basaran MD.

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Basaran, D., Dusek, L., Majek, O. et al. Oncological Outcomes of Nerve-Sparing Radical Hysterectomy for Cervical Cancer: A Systematic Review. Ann Surg Oncol 22, 3033–3040 (2015). https://doi.org/10.1245/s10434-015-4377-7

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  • DOI: https://doi.org/10.1245/s10434-015-4377-7

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