Francesco Raspagliesi1, Giorgio Bogani2, Arsenio Spinillo3, Antonino Ditto1, Stefano Bogliolo3, Jvan Casarin4, Umberto Leone Roberti Maggiore5, Fabio Martinelli1, Mauro Signorelli1, Barbara Gardella3, Valentina Chiappa1, Cono Scaffa1, Simone Ferrero6, Antonella Cromi4, Domenica Lorusso1, Fabio Ghezzi4. 1. Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy. 2. Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy. Electronic address: giorgio.bogani@istitutotumori.mi.it. 3. Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy. 4. Obstetrics and Gynecology, University of Insubria, Ospedale di Circolo, Fondazione Macchi, Varese, Italy. 5. Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy; Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy. 6. Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.
Abstract
OBJECTIVE: To evaluate the impact of nerve-sparing (NS) approach on outcomes of patients undergoing minimally invasive radical hysterectomy (MRH) for locally advanced stage cervical cancer (LACC). METHODS: Data of consecutive patients undergoing minimally invasive surgery for LACC were retrospectively retrieved in a multi-institutional setting from 2009 to 2016. All patients included had minimally invasive class III radical hysterectomy (MRH or NS-MRH). Propensity matching algorithm was used to decrease possible allocation bias when comparing outcomes between groups. RESULTS: Overall, 83 patients were included. The prevalence of patients undergoing NS approach increased aver the study period (from 7% in the year 2009-2010 to 97% in the year 2015-2016; p-for-trend < 0.001). NS-MRH and MRH were performed in 47 (57%) and 36 (43%) patients, respectively. After the application the propensity-matching algorithm, we compared 35 patients' pair (total 70 patients). Postoperative complications rate was similar between groups. Patients undergoing NS-LRH experienced shorter hospital stay than patients undergoing LRH (3.6 vs. 5.0 days). 60-day pelvic floor dysfunction rates, including voiding, fecal and sexual alterations, were lower in the NS group in comparison to control group (p = 0.02). Five-year disease-free (p = 0.77) and overall (p = 0.36) survivals were similar comparing NS-MRH with MRH. CONCLUSIONS: The implementation of NS approach in the setting of LACC improves patients' outcomes, minimizing pelvic dysfunction rates. NS approach has not detrimental effects on survival outcomes.
OBJECTIVE: To evaluate the impact of nerve-sparing (NS) approach on outcomes of patients undergoing minimally invasive radical hysterectomy (MRH) for locally advanced stage cervical cancer (LACC). METHODS: Data of consecutive patients undergoing minimally invasive surgery for LACC were retrospectively retrieved in a multi-institutional setting from 2009 to 2016. All patients included had minimally invasive class III radical hysterectomy (MRH or NS-MRH). Propensity matching algorithm was used to decrease possible allocation bias when comparing outcomes between groups. RESULTS: Overall, 83 patients were included. The prevalence of patients undergoing NS approach increased aver the study period (from 7% in the year 2009-2010 to 97% in the year 2015-2016; p-for-trend < 0.001). NS-MRH and MRH were performed in 47 (57%) and 36 (43%) patients, respectively. After the application the propensity-matching algorithm, we compared 35 patients' pair (total 70 patients). Postoperative complications rate was similar between groups. Patients undergoing NS-LRH experienced shorter hospital stay than patients undergoing LRH (3.6 vs. 5.0 days). 60-day pelvic floor dysfunction rates, including voiding, fecal and sexual alterations, were lower in the NS group in comparison to control group (p = 0.02). Five-year disease-free (p = 0.77) and overall (p = 0.36) survivals were similar comparing NS-MRH with MRH. CONCLUSIONS: The implementation of NS approach in the setting of LACC improves patients' outcomes, minimizing pelvic dysfunction rates. NS approach has not detrimental effects on survival outcomes.
Authors: Chia-Hao Liu; Yu-Chieh Lee; Jeff Chien-Fu Lin; I-San Chan; Na-Rong Lee; Wen-Hsun Chang; Wei-Min Liu; Peng-Hui Wang Journal: Int J Environ Res Public Health Date: 2019-10-11 Impact factor: 3.390