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

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

Abstract

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] 72.0–85.7) in NSRH and 79.8% (95% CI 75.3–84.3) in RH (P = 0.519). Five-year overall survival estimate was 90.8% (95% CI 85.9–95.6) in NSRH and 84.1% (95% CI 8.0–88.3) 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.

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References

  1. Meigs JV. Radical hysterectomy with bilateral dissection of pelvic lymph nodes: surgical treatment of cancer of the cervix. New York: Grune & Stratton; 1954.

    Google Scholar 

  2. Kobayashi T. Abdominal radical hysterectomy with pelvic lymphadenectomy for cancer of the cervix. Tokyo: Nanzando; 1961. p. 178–87.

  3. Fujii S. Anatomic identification of nerve-sparing radical hysterectomy: a step-by-step procedure. Gynecol Oncol. 2008;111(2 Suppl):S33–41.

    Article  PubMed  Google Scholar 

  4. Yabuki Y, Asamoto A, Hoshiba T, et al. Dissection of the cardinal ligament in radical hysterectomy for cervical cancer with emphasis on the lateral ligament. Am J Obstet Gynecol. 1991;164:7–14.

    PubMed  CAS  Google Scholar 

  5. Hockel M, Konerding MA, Heussel CP. Liposuction-assisted nerve-sparing extended radical hysterectomy: oncologic rationale, surgical anatomy, and feasibility study. Am J Obstet Gynecol. 1998;178:971–6.

    Article  PubMed  CAS  Google Scholar 

  6. Possover M, Stober S, Plaul K, et al. Identification and preservation of the motoric innervation of the bladder in radical hysterectomy type III. Gynecol Oncol. 2000;79:154–7.

    Article  PubMed  CAS  Google Scholar 

  7. Trimbos JB, Maas CP, Deruiter MC, et al. A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients. Int J Gynecol Cancer. 2001;11:180–6.

    Article  PubMed  CAS  Google Scholar 

  8. Raspagliesi F, Ditto A, Fontanelli R, et al. Nerve-sparing radical hysterectomy: a surgical technique for preserving the autonomic hypogastric nerve. Gynecol Oncol. 2004;93:307–14.

    Article  PubMed  Google Scholar 

  9. Ditto A, Martinelli F, Borreani C, et al. Quality of life and sexual, bladder, and intestinal dysfunctions after class III nerve-sparing and class II radical hysterectomies: a questionnaire-based study. Int J Gynecol Cancer. 2009;19:953–7.

    Article  PubMed  Google Scholar 

  10. Papp Z, Csapo Z, Hupuczi P, et al. Nerve-sparing radical hysterectomy for stage IA2–IIB cervical cancer: 5-year survival of 501 consecutive cases. Eur J Gynaecol Oncol. 2006;27:553–60.

    PubMed  CAS  Google Scholar 

  11. Van den Tillaart SA, Kenter GG, Peters AA, et al. Nerve-sparing radical hysterectomy: local recurrence rate, feasibility, and safety in cervical cancer patients stage IA to IIA. Int J Gynecol Cancer. 2009;19:39–45.

    Article  PubMed  Google Scholar 

  12. Skret-Magierło J, Naróg M, Kruczek A, et al. Radical hysterectomy during the transition period from traditional to nerve-sparing technique. Gynecol Oncol. 2010;116:502–5.

    Article  PubMed  Google Scholar 

  13. Ditto A, Martinelli F, Hanozet F, et al. Class III NSRH: oncological outcome in 170 cervical cancer patients. Gynecol Oncol. 2010;119:192–7.

    Article  PubMed  Google Scholar 

  14. Pecorelli S. FIGO Committee on Gynecologic Oncology. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105:103–4.

    Article  Google Scholar 

  15. Raspagliesi F, Ditto A, Kusamura S, et al. Nerve-sparing radical hysterectomy: a pilot study. Tumori. 2003;89:497–501.

    PubMed  Google Scholar 

  16. Raspagliesi F, Ditto A, Hanozet F, et al. Nerve sparing radical hysterectomy for the treatment of cervical cancer: new research on surgical techniques. In: Varaj HT, editor. Trends in cervical cancer research. Hauppauge, NY: Nova Science Publishers; 2007. p. 97–123.

  17. Korn EL, Dorey FJ. Applications of crude incidence curves. Stat Med. 1992;11:813–29.

    Article  PubMed  CAS  Google Scholar 

  18. Gray RJ. A class of k-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat. 1988;16:1141–54.

    Article  Google Scholar 

  19. Schoenfeld D. Partial residuals for the proportional hazards regression model. Biometrika. 1982;69:239–41.

    Article  Google Scholar 

  20. Brucker PS, Yost K, Cashy J, et al. General population and cancer patient norms for the Functional Assessment of Cancer Therapy-General (FACT-G). Eval Health Prof. 2005;28:192–211.

    Article  PubMed  Google Scholar 

  21. Landoni F, Maneo A, Cormio G, et al. Class II versus class III radical hysterectomy in stage IB–IIA cervical cancer: a prospective randomized study. Gynecol Oncol. 2001;80:3–12.

    Article  PubMed  CAS  Google Scholar 

  22. Girardi F, Lichtenegger W, Tamussino K, et al. The importance of parametrial lymph nodes in the treatment of cervical cancer. Gynecol Oncol. 1989;34:206–11.

    Article  PubMed  CAS  Google Scholar 

  23. Benedetti-Panici P, Maneschi F, Scambia G, et al. Lymphatic spread of cervical cancer: an anatomical and pathological study based on 225 radical hysterectomies with systematic pelvic and aortic lymphadenectomy. Gynecol Oncol. 1996;62:19–24.

    Article  PubMed  CAS  Google Scholar 

  24. Raspagliesi F, Ditto A, Hanozet F, et al. Nerve-sparing radical hysterectomy in cervical cancer evolution of concepts. Gynecol Oncol. 2007;107(1 Suppl 1):S119–21.

    Google Scholar 

  25. 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;102:256–62.

    Article  PubMed  Google Scholar 

  26. Samlal RA, Van der Velden J, Van Eerden T, et al. Recurrent cervical carcinoma after radical hysterectomy: an analysis of clinical aspects and prognosis. Int J Gynecol Cancer. 1998;8:78–84.

    Article  PubMed  Google Scholar 

  27. Benedetti-Panici P, Greggi S, Colombo A, et al. Neoadjuvant chemotherapy and radical surgery versus exclusive radiotherapy in locally advanced squamous cell cervical cancer: results from the Italian multicenter randomized study. J Clin Oncol. 2002;20:179–88.

    Article  PubMed  CAS  Google Scholar 

  28. Buda A, Fossati R, Colombo N, et al. Randomized trial of neoadjuvant chemotherapy comparing paclitaxel, ifosfamide, and cisplatin with ifosfamide and cisplatin followed by radical surgery in patients with locally advanced squamous cell cervical carcinoma: the SNAP01 (Studio Neo-Adjuvante Portio) Italian Collaborative Study. J Clin Oncol. 2005;23:4137–45.

    Article  PubMed  CAS  Google Scholar 

  29. Lissoni AA, Colombo N, Pellegrino A, et al. A phase II, randomized trial of neo-adjuvant chemotherapy comparing a three-drug combination of paclitaxel, ifosfamide, and cisplatin (TIP) versus paclitaxel and cisplatin (TP) followed by radical surgery in patients with locally advanced squamous cell cervical carcinoma: the Snap-02 Italian Collaborative Study. Ann Oncol. 2009;20:660–5.

    Article  PubMed  CAS  Google Scholar 

  30. Trimbos JB, Franchi M, Zanaboni F, et al. “State of the art” of radical hysterectomy; current practice in European oncology centres. Eur J Cancer. 2004;40:375–8.

    Article  PubMed  CAS  Google Scholar 

  31. Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol. 2008;9:297–303.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

All authors have participated in data collection, data analysis, and the writing of the paper. None of the authors has a conflict of interest. No funds have been received for this work. The study was approved by the institutional ethics committee.

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Authors and Affiliations

  1. Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy

    Antonino Ditto MD, Fabio Martinelli MD, Eugenio Solima MD & Francesco Raspagliesi MD

  2. Unit of Clinical Epidemiology and Trial Organisation, IRCCS National Cancer Institute, Milan, Italy

    Flavia Mattana ScD & Luigi Mariani MD

  3. Department of Obstetrics and Gynaecology, Treviglio/Caravaggio Hospital, Bergamo, Italy

    Claudio Reato MD

  4. Department of Pathology, IRCCS National Cancer Institute, Milan, Italy

    Marialuisa Carcangiu MD

  5. Department of Anesthesiology, IRCCS National Cancer Institute, Milan, Italy

    Edward Haeusler MD

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  1. Antonino Ditto MD
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  2. Fabio Martinelli MD
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Correspondence to Antonino Ditto MD.

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Ditto, A., Martinelli, F., Mattana, F. et al. Class III Nerve-sparing Radical Hysterectomy Versus Standard Class III Radical Hysterectomy: An Observational Study. Ann Surg Oncol 18, 3469–3478 (2011). https://doi.org/10.1245/s10434-011-1767-3

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  • DOI: https://doi.org/10.1245/s10434-011-1767-3

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