Laparoscopic Nerve-Sparing Radical Hysterectomy vs Laparoscopic Radical Hysterectomy in Cervical Cancer: A Systematic Review and Meta-Analysis of Clinical Efficacy and Bladder Dysfunction.
Adult
Female
Humans
Hysterectomy
/ adverse effects
Laparoscopy
/ adverse effects
Lymph Node Excision
Middle Aged
Neoplasm Staging
Organ Sparing Treatments
/ adverse effects
Postoperative Complications
/ epidemiology
Treatment Outcome
Urinary Bladder
/ pathology
Urinary Bladder Diseases
/ epidemiology
Uterine Cervical Neoplasms
/ epidemiology
Uterus
/ innervation
Bladder dysfunction
Cervical cancer
Laparoscopic radical hysterectomy
Nerve-sparing
Urodynamic measurement
Journal
Journal of minimally invasive gynecology
ISSN: 1553-4669
Titre abrégé: J Minim Invasive Gynecol
Pays: United States
ID NLM: 101235322
Informations de publication
Date de publication:
Historique:
received:
01
09
2018
revised:
15
10
2018
accepted:
15
10
2018
pubmed:
26
10
2018
medline:
8
8
2019
entrez:
26
10
2018
Statut:
ppublish
Résumé
It is widely accepted that nerve-sparing radical hysterectomy is associated with less postoperative morbidity compared with radical hysterectomy, whereas clinical safety is similar in the 2 procedures. However, there is insufficient evidence to compare these procedures performed via a laparoscopic approach. We performed a systematic review and meta-analysis of studies to compare the clinical efficacy and the rate of bladder dysfunction, including urodynamic assessment, in laparoscopic nerve-sparing radical hysterectomy (LNSRH) and laparoscopic radical hysterectomy (LRH). Thirty articles including a total of 2743 participants were analyzed. Operating times were shorter (MD, 29.88 minutes; 95% confidence interval [CI], 11.92-47.83 minutes) and hospital stays were longer (MD, -1.56 days; 95% CI, -2.27 to -0.84 days) in the LRH group compared with the LNSRH group. In addition, blood loss and the number of resected lymph nodes were not significantly different between the 2 groups. However, resected parametrium length (MD, -0.02 cm; 95% CI, -0.05 to -0.00 cm) and vaginal cuff width (MD, -0.06 cm; 95% CI, -0.09 to -0.04) were smaller in the LNSRH group. Furthermore, LNSRH tended to result in more satisfactory micturition (odds ratio, 2.90; 95% CI, 2.01-4.19), shorter catheterization time (MD, -7.20 days; 95% CI, -8.10 to -6.29 days), and shorter recovery to normal postvoid residual urine time (MD, -7.71 days; 95% CI, -8.92 to -6.50 days). Other bladder dysfunction symptoms, including urinary retention, nocturia, dysuria, urinary incontinence, and frequency/urgency were more frequent in the LRH group. Furthermore, LNSRH achieved better results in urodynamic assessments (all p < .05). In conclusion, LNSRH was associated with lower rates of impaired bladder function and a shorter extent of resection compared with LRH. Clinical applications involving LNSRH should be explored with caution.
Identifiants
pubmed: 30359783
pii: S1553-4650(18)31317-7
doi: 10.1016/j.jmig.2018.10.012
pii:
doi:
Types de publication
Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Pagination
417-426.e6Informations de copyright
Copyright © 2018 AAGL. Published by Elsevier Inc. All rights reserved.