Class III Nerve-sparing Radical Hysterectomy Versus Standard Class III Radical Hysterectomy: An Observational Study

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• 作者：Antonino Ditto MD (1)
  Fabio Martinelli MD (1)
  Flavia Mattana ScD (2)
  Claudio Reato MD (3)
  Eugenio Solima MD (1)
  Marialuisa Carcangiu MD (4)
  Edward Haeusler MD (5)
  Luigi Mariani MD (2)
  Francesco Raspagliesi MD (1)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2011
• 出版时间：November 2011
• 年：2011
• 卷：18
• 期：12
• 页码：3469-3478
• 全文大小：1712KB
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• 作者单位：Antonino Ditto MD (1)
  Fabio Martinelli MD (1)
  Flavia Mattana ScD (2)
  Claudio Reato MD (3)
  Eugenio Solima MD (1)
  Marialuisa Carcangiu MD (4)
  Edward Haeusler MD (5)
  Luigi Mariani MD (2)
  Francesco Raspagliesi MD (1)
  
  1. Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy
  2. Unit of Clinical Epidemiology and Trial Organisation, IRCCS National Cancer Institute, Milan, Italy
  3. Department of Obstetrics and Gynaecology, Treviglio/Caravaggio Hospital, Bergamo, Italy
  4. Department of Pathology, IRCCS National Cancer Institute, Milan, Italy
  5. Department of Anesthesiology, IRCCS National Cancer Institute, Milan, Italy
  

文摘

Background The purpose of this observational study was to evaluate disease-free survival, overall survival, local recurrence rate, and morbidities in patients submitted to class III nerve-sparing radical hysterectomy (NSRH) compared with standard radical hysterectomy (RH) in cervical cancer (CC). This was a comparative study in the context of multimodal therapies. Materials and Methods We investigated patients with CC admitted to the National Cancer Institute of Milan between January 4, 2001, and September 29, 2009, treated with NSRH. We compared patients operated with RH between March 20, 1980, and December 28, 1995. A total of 496 patients were enrolled. The median follow-up was 93?months (42 and 159?months for the NSRH and RH groups, respectively). Results The overall number of relapses was 30 out of 185 and 60 out of 311 for NSRH and RH, respectively. Five-year disease-free survival estimate was 78.9% (95% confidence interval [CI] 72.0-5.7) in NSRH and 79.8% (95% CI 75.3-4.3) in RH (P?=?0.519). Five-year overall survival estimate was 90.8% (95% CI 85.9-5.6) in NSRH and 84.1% (95% CI 8.0-8.3) in RH (P?=?0.192). Rates of postoperative serious complications were 9.7% and 19.6% for NSRH and RH, respectively (P?=?0.004). Positive pelvic lymph node and vagina status were significant (P?<?0.01) independent predictors by multivariable analyses. Conclusions The oncologic results were comparable between NSRH and conventional class III RH in the context of two multimodal treatments. Bladder function and postoperative complications rate are improved by nerve-sparing technique. The nerve-sparing technique should be considered in all CC patients addressed to surgery because it improves functional outcome and preserves radicality without compromising overall survival.