Article Text

Download PDFPDF
Long-Term Oncological Outcome After Conventional Radical Hysterectomy Versus 2 Nerve-Sparing Modalities for Early Stage Cervical Cancer
  1. Mignon Dingena Johanna Maria van Gent, MD*,
  2. Mandy Rademaker, MD*,
  3. Johanna Cornelia Bernadette van der Veer, MD*,
  4. Mariëtte Inie Elizabeth van Poelgeest, MD, PhD*,
  5. Katja Nicoline Gaarenstroom, MD, PhD*,
  6. Hein Putter, MD, PhD,
  7. Johannes Baptist Maria Zacharias Trimbos, MD, PhD* and
  8. Cor Doede de Kroon, MD, PhD*
  1. *Departments of Gynaecology,
  2. Departments of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands.
  1. Address correspondence and reprint requests to Mignon Dingena Johanna Maria van Gent, MD, Department of Gynaecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. E-mail: M.D.J.M.van_Gent@lumc.nl; m.v.gent@nki.nl.

Abstract

Objectives Nerve-sparing radical hysterectomy for early stage cervical cancer was introduced to improve quality of life after treatment. Sparing the pelvic autonomic nerves reduces bladder, bowel, and sexual dysfunction. The Leiden nerve-sparing radical hysterectomy (LNSRH) was modified to the Swift procedure, the latter being more radical regarding the sacrouterine and parametrial resection. We investigate whether nerve-sparing surgery has comparable oncological outcomes as the conventional radical hysterectomy (CRH). Concurrently, we investigate whether there is a difference regarding the oncological outcomes of the 2 nerve-sparing techniques.

Methods This is a single-center, observational prospective cohort study analyzing oncological outcomes in women undergoing CRH (1994–1999), LNSRH (2001–2005), or Swift procedure (2006–2010) for early stage cervical cancer (International Federation of Gynecology and Obstetrics IA2–IIA).

Results Three hundred sixty-three patients (124 CRH, 122 LNSRH, and 117 Swift) were included. International Federation of Gynecology and Obstetrics stage IB2 or higher (P = 0.005) was significantly more prevalent in the CRH cohort. The 5-year pelvic relapse–free survival and overall survival were not significantly different between the 3 cohorts (P = 0.116). Regarding the nerve-sparing cohorts, the Swift cohort showed a significant better 5-year overall survival (87.2%) compared with the LNSRH cohort (78.8%) (P = 0.04). In the LNSRH cohort, resection planes less than 5 mm free and need for adjuvant therapy were significantly higher than in the Swift cohort (P = 0.026 and 0.046, respectively).

Conclusions The nerve-sparing radical hysterectomy shows a similar oncological outcome compared with the CRH. The more radical Swift version of nerve-sparing techniques is preferable to the former LNSRH procedure.

  • Nerve-sparing
  • Cervical cancer
  • Radical hysterectomy
  • Survival
  • Swift

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Footnotes

  • The authors declare no conflicts of interest.

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.ijgc.net).