Safety and Efficacy of Laparoscopic Nerve-Sparing Radical Hysterectomy in the Treatment of Early Cervical Cancer: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LU Yan ,  YAO Desheng , OU Tingyu

Department of Gynecological Oncology, Cancer Hospital of Guang Xi Medical University, Nanning 530021, China;

Corresponding author：

YAO Desheng, Email: yaodeson@163.com

Keywords：

Cervical cancer; Laparoscope; Nerve-sparing radical hysterectomy; Dysfunction of the bladder; Meta-analysis

DOI：

10.7507/1672-2531.20120109

Video：

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Objective To assess the efficacy and safety of laparoscopic nerve-sparing radical hysterectomy (LNSRH) in treatment of early cervical cancer.
Methods Such databases as CBM (1960 to September 2011), CENTRAL (1966 to September 2011), MEDLINE (1966 to September 2011), The Cochrane Library, EMbase (1974 to September 2011) and CNKI (1994 to September 2011) were searched on computer, and relevant magazines were also searched manually. Data were extracted and the quality was assessed after including studies according to exclusive criteria, then meta-analysis was conducted using RevMan 5.1 software.
Results Total 7 studies involving 506 cases were selected, of which 255 cases were in the LNSRH group and the other 251 cases were in the laparoscopic radical hysterectomy (LRH) group. There were no differences between the two groups in age, body mass index, clinical stage, pathological type and histological grade. The results of meta-analysis showed that: a) The operative time of LNSRH was longer than LRH, with significant difference (P=0.02). But there was no significant difference in intraoperative bleeding between the two groups (P=0.69); b) The length of dissected parametrium of LNSRH was shorter than LRH with significant difference (P=0.02). But there was no significant difference in the length of dissected vagina (P=0.69); and c) The functional recovery of the bladder in the LNSRH group was better than LRH (P lt;0.000 01).
Conclusion LNSRH is safe and feasible in effectively alleviating the postoperative dysfunction of the bladder in early cervical cancer as well as in improving the quality of life for patients. It is regarded as a new model of operation. Because it has just been put into practice within a short time, and there is lack of multi-center, large-sample, prospective controlled studies at present, so its radical effectiveness, long-term recurrence rate, survival rate, etc. have not yet been confirmed. More high quality studies are needed to provide important data of comparison between LNSRH and LRH.

Citation： LU Yan,YAO Desheng,OU Tingyu. Safety and Efficacy of Laparoscopic Nerve-Sparing Radical Hysterectomy in the Treatment of Early Cervical Cancer: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2012, 12(6): 666-671. doi: 10.7507/1672-2531.20120109 Copy

1.	李艳, 梁志清, 陈勇, 等. 腹腔镜下保留盆腔神经丛的根治性子宫切除术的临床观察. 重庆医学, 2009, 38(15): 1910-1912.
2.	陈勇, 李燕, 徐惠成, 等. 腹腔镜下保留盆腔植物神经的解剖性广泛性子宫切除术37例临床分析. 中华妇产科杂志, 2009, 44(5): 359-363.
3.	刘青, 李培全, 刘开江, 等. 腹腔镜下保留盆腔神经功能的宫颈癌根治术近期疗效的比较研究. 中国微创外科杂志, 2010, 14(12): 1082-1085.
4.	Liang Z, Chen Y, Xu H, et al. Laparoscopic nerve-sparing radical hysterectomy with fascia space dissection technique for cervical cancer: description of technique and outcomes. Gynecol Oncol, 2010, 119(2): 202-207.
5.	张勇, 王丹, 马瑛, 等. 腹腔镜保留神经宫颈癌根治术的临床研究. 现代妇产科进展, 2010, 19(1): 30-32.
6.	赵倩, 边爱平, 张君玲, 等. 腹腔镜保留神经的广泛子宫切除术治疗宫颈癌临床分析. 中国妇幼保健, 2011(1): 14-16.
7.	朱芳芳, 朱前勇, 郭伟平, 等. 腹腔镜下系统保留盆腔自主神经的广泛性子宫切除术治疗早期宫颈癌38例. 重庆医学, 2011, 40(21): 2128-2130.
8.	Li G, Yan X, Shang H, et al. A comparison of laparoscopic radical hysterectomy and pelvic lymphadenectomy and laparotomy in the treatment of Ib-IIa cervical cancer. Gynecol Oncol, 2007, 105(1): 176-180.
9.	Frumovitz M, Dos RR, Sun CC, et al. Comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer. Obstet Gynecol, 2007, 110(1): 96-102.
10.	Raspagliesi F, Ditto A, Fontanelli R, et al. Type II versus Type III nerve-sparing radical hysterectomy: comparison of lower urinary tract dysfunctions. Gynecol Oncol, 2006, 102(2): 256-262.
11.	Fujii S, Takakura K, Matsumura N, et al. Anatomic identification and functional outcomes of the nerve sparing Okabayashi radical hysterectomy. Gynecol Oncol, 2007, 107(1): 4-13.
12.	Fujii S. Anatomic identification of nerve-sparing radical hysterectomy: a step-by-step procedure. Gynecol Oncol, 2008, 111(2 Suppl): S33-S41.
13.	Skret A, Nowakowski B, Skret-Magierlo J, et al. [Nerve sparing radical hysterectomy]. Ginekol Pol, 2008, 79(2): 92-98.

1. 李艳, 梁志清, 陈勇, 等. 腹腔镜下保留盆腔神经丛的根治性子宫切除术的临床观察. 重庆医学, 2009, 38(15): 1910-1912.
2. 陈勇, 李燕, 徐惠成, 等. 腹腔镜下保留盆腔植物神经的解剖性广泛性子宫切除术37例临床分析. 中华妇产科杂志, 2009, 44(5): 359-363.
3. 刘青, 李培全, 刘开江, 等. 腹腔镜下保留盆腔神经功能的宫颈癌根治术近期疗效的比较研究. 中国微创外科杂志, 2010, 14(12): 1082-1085.
4. Liang Z, Chen Y, Xu H, et al. Laparoscopic nerve-sparing radical hysterectomy with fascia space dissection technique for cervical cancer: description of technique and outcomes. Gynecol Oncol, 2010, 119(2): 202-207.
5. 张勇, 王丹, 马瑛, 等. 腹腔镜保留神经宫颈癌根治术的临床研究. 现代妇产科进展, 2010, 19(1): 30-32.
6. 赵倩, 边爱平, 张君玲, 等. 腹腔镜保留神经的广泛子宫切除术治疗宫颈癌临床分析. 中国妇幼保健, 2011(1): 14-16.
7. 朱芳芳, 朱前勇, 郭伟平, 等. 腹腔镜下系统保留盆腔自主神经的广泛性子宫切除术治疗早期宫颈癌38例. 重庆医学, 2011, 40(21): 2128-2130.
8. Li G, Yan X, Shang H, et al. A comparison of laparoscopic radical hysterectomy and pelvic lymphadenectomy and laparotomy in the treatment of Ib-IIa cervical cancer. Gynecol Oncol, 2007, 105(1): 176-180.
9. Frumovitz M, Dos RR, Sun CC, et al. Comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer. Obstet Gynecol, 2007, 110(1): 96-102.
10. Raspagliesi F, Ditto A, Fontanelli R, et al. Type II versus Type III nerve-sparing radical hysterectomy: comparison of lower urinary tract dysfunctions. Gynecol Oncol, 2006, 102(2): 256-262.
11. Fujii S, Takakura K, Matsumura N, et al. Anatomic identification and functional outcomes of the nerve sparing Okabayashi radical hysterectomy. Gynecol Oncol, 2007, 107(1): 4-13.
12. Fujii S. Anatomic identification of nerve-sparing radical hysterectomy: a step-by-step procedure. Gynecol Oncol, 2008, 111(2 Suppl): S33-S41.
13. Skret A, Nowakowski B, Skret-Magierlo J, et al. [Nerve sparing radical hysterectomy]. Ginekol Pol, 2008, 79(2): 92-98.

Chinese Journal of Evidence-Based Medicine

Safety and Efficacy of Laparoscopic Nerve-Sparing Radical Hysterectomy in the Treatment of Early Cervical Cancer: A Meta-Analysis

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