[Open nerve-plane sparing radical hysterectomy in locally advanced cervical cancer: evaluation on efficacy and long-term survival outcomes]

Objective: To evaluate the security and clinical outcomes of open nerve-plane sparing radical hysterectomy (NPSRH) for operable locally advanced cervical cancer, compared with conventional radical hysterectomy (CRH). Methods: All 389 cases with International Federation of Gynecology and Obstetrics (FIGO, 2009) stage Ⅰb2 and Ⅱa2 cervical cancer were retrospectively analyzed in Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences between January 2008 and December 2014. Of all the patients, 69 cases underwent laparotomic NPSRH, and other 320 cases underwent CRH. Patients' general characteristics and intraoperative parameters were evaluated between the two groups. Basic clinical and pathological informations between the two groups were matched. After median 82 months' follow-up,disease-free survival (DFS), overall survival (OS), and postoperative recovery of bladder function were compared between the two groups. Results: (1) Compared to CRH group, NPSRH group had less intraoperative bleeding [(366±302) vs (457±301) ml; t=2.305, P=0.022], and a little bit longer operation time [(262±51) vs (245±52) minutes; t=2.621, P=0.009]. (2) Compared to CRH group, NPSRH group had shorter duration of urethral catheterization [(11±9) vs (16±7) days; t=3.906, P<0.01], and better postoperative bladder sensation and function in one year (6.1% vs 16.0%; χ2=4.418, P=0.036). (3) The 5-year DFS rate and 5-year OS rate of all patients were 89.6% and 89.9%, respectively. Either preserving pelvic autonomic nerves or not had little effect on the 5-year DFS rate (NPSRH vs CRH: 90.9% vs 89.4%; P=0.714) or on 5-year OS rate (NPSRH vs CRH: 90.0% vs 89.9%; P=0.910) for locally advanced cervical cancer. Univariate analysis showed that lymphatic vascular space infiltration (LVSI) and pelvic lymphatic metastasis were significantly correlated with prognosis (P<0.05). Multivariate analysis showed that pelvic lymphatic metastasis was the independent prognostic factor of 5-year DFS rate (HR=1.31, 95%CI: 1.01-1.68, P=0.040) as well as 5-year OS rate (HR=1.30, 95%CI: 1.01-1.67, P=0.046) for locally advanced cervical cancer. Conclusion: Open NPSRH is feasible for patients with locally advanced cervical cancer, which could improve both short-term and long-term bladder function, and is not a risk factor for the prognosis of patients.