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EP398 Nerve-sparing radical hysterectomy: a standardized method for precision surgery and local control in cervical cancer
  1. N Sakuragi1,2,
  2. T Kato1,
  3. G Murakami3,4,
  4. C Shimada1,
  5. Y Todo5,
  6. M Kaneuchi2,
  7. T Mitamura1,
  8. Y Konno1,
  9. M Takeda1,
  10. M Kudo1 and
  11. H Watari1
  1. 1Department of Obstetrics and Gynecology, Graduate School of Medicine, Hokkaido University, Sapporo
  2. 2Department of Gynecology, Otaru General Hospital, Otaru
  3. 3Department of Anatomy II, Sapporo Medical University
  4. 4Division of Internal Medicine, Jikou-kai Clinic of Home Visits
  5. 5Department of Gynecology, Hokkaido Cancer Center, Sapporo, Japan

Abstract

Introduction/Background We aimed to evaluate the efficacy of a systematic nerve-sparing radical hysterectomy (NS-RH) developed by Japanese gynecologists1–3in terms of local control of cervical cancer.

Methodology One-hundred and twenty-one patients with FIGO stage IB1 (n=72)/IB2 (n=13)/IIA (n=9)/IIB (n=27) cervical cancer treated with RH (with or without NS procedure) between 2002 and 2011 were studied. NS procedure was applied when feasible bilaterally or unilaterally. Tumor recurrence included pelvic (local/regional) and distant (extrapelvic) failures. Median follow-up was 106 (range: 6–203) months. The number of loss to follow-up was 4 (3.3%) at 60 months.

Results Sites of recurrence (some overlapped) were local (n=7), regional (6), and distant (n=11). 5-year overall (OS) and disease-free survival (DFS) for stage IB1 were 97.2%% and 94.1% and for stage IB2 were 92.3% and 84.6%, respectively. For stage IIA (combined IIA1 and IIA2) and stage IIB, 5-year OS and DFS rates were 77.8% and 66.7%; 77.8% and 70.4%, respectively. Overall and local recurrence rates in stage IB1/IB2 were 6/85 (7.1%) and 1/85 (1.2%), respectively; in IIA/IIB was 12/36 (33.3%) and 6/36 (16.7%), respectively. Four (1 stage IB1 and 3 stage IIB) of seven local recurrence occurred in the paracolpium or pararectum area on the same side of NSprocedure and the other three were deemed to have no relationship with NSprocedure. NS-related local recurrence in stage IB1/IB2/IIA and IIB was 1/94 (1.1%) and 3/27 (11.1%), respectively (p=0.034). Both overall recurrence and NS-related local recurrence were better correlated to pT classification (p<0.001 and p<0.001) than FIGO stage (p=0.002 and p=0.008).

Conclusion Japanese method of NS-RH can be safely applied to 2008 FIGO stage IB1/IB2/IIA cervical cancer unless histological vaginal and parametrial invasion is suspected. Modern imaging techniques, which can be used in 2018 FIGO staging, may be useful for personalized application of NS-RH for cervical cancer.

References

  1. Yabuki Y, Asamoto A, Hoshiba T, Nishimoto H, Satou N. A new proposal for radical hysterectomy. Gynecol Oncol 1996; 62: 370-8.

  2. Sakuragi N, Todo Y, Kudo M, Yamamoto R, Satp T. A systematic nerve-sparing radical hysterectomy technique in invasive cervival cancer for preserving postsurgical bladder function. Int J Gynecol Cancer 2005; 15: 389-97.

  3. Fujii S, Takakura k, Matsumura N, et al. Anatomic identification and fuctional outcmes of the nerve sparing Okabayshi radical hysterectomy. Gyneco Oncol 2007; 107: 4-13.

Disclosure NS has received chairperson’s fees from J & J and Chugai and research grants from Roche and Chugai. HW received research grants or lecture fees from Chugai and Lymphotec. TK, CS, MK, MT and YK declare that they have no conflicts of interest. NS and TK contributed equally to this work.

Abstract EP398 Figure 1
Abstract EP398 Figure 1

Various types of RH used in Japan and the corresponding classificatications

http://dx.doi.org/10.1136/ijgc-2019-ESGO.457

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