Nerve Sparing Approach Improves Outcomes of Patients Undergoing Minimally Invasive Radical Hysterectomy: a Systematic Review and Meta-Analysis.
Nerve-Sparing Approach Improves Outcomes of Patients Undergoing Minimally Invasive Radical Hysterectomy: A Systematic Review and Meta-Analysis
Few studies investigated the efficacy and safety of nerve sparing approach via minimally invasive surgery for the treatment of cervical cancer. We aimed to review the current evidence comparing nerve sparing minimally invasive radical hysterectomy (NS-MRH) and conventional minimally invasive radical hysterectomy (MRH). This systematic review was registered in the International Prospective Register of Systematic Reviews (CRD#57655). Overall, 675 patients were included: 350 (51.9%) and 325 (48.1%) patients undergoing MRH and NS-MRH, respectively. MRH was associated with a shorter operative time in comparison to NS-MRH (mean difference 32.57 minutes, 22.87-42.48). Estimated blood loss (mean difference 97.14 mL, 20.01-214.29) and transfusion rate (OR: 0.67; 95%CI: 0.15, 3.01) did not deferrer statistically between two groups.
The risk of developing intra-operative (OR: 0.43; 95%CI: 0.08, 2.23) and severe postoperative (OR: 0.63; 95%CI: 0.17, 2.39) complications was similar between NS-MRH and MRH. Patients undergoing NSMRH experienced lower voiding (OR: 0.39; 95%CI: 0.19, 0.81) dysfunction rates than patients undergoing MRH. Moreover, a trend towards lower sexual (OR: 0.25; 95%CI: 0.06, 1.07) and rectal (OR: 0.12; 95%CI: 0.01, 1.02) issues was observed for patients having NS-MRH than patients undergoing MRH. Survival outcomes are not influenced by type of surgical approach: recurrence (OR: 1.27; 95%CI: 0.49, 3.28) and death (OR: 1.01; 95%CI: 0.36, 2.83) rates. Pooled data suggested that the NS-MRH is equivalent to MRH for the treatment of cervical cancer and may be superior reducing pelvic floor dysfunction rates. However, because of the low level of evidence of the included studies, further randomized trials are warranted.