Nerve-sparing radical hysterectomy: II. Results after three years

Objective: To improve the therapeutic index of the surgical treatment of ce rvical cancer with a nerve-sparing approach to radical hysterectomy. Methods: Between July 1996 and October 1999 a total of 41 patients with sta ge IB1 to IIB cervical cancer underwent nerve-sparing radical hysterectomy. Clinical, histopathologic, neurophysiologic and imaging results were compa red with two historical control groups of patients who underwent traditiona l radical hysterectomy. Results: All tumors were resected with clear margins (R0). There were no in traoperative or short-term postoperative complications. Histopathology of t he surgical specimens and magnetic resonance imaging studies showed that mo re parametrial tissue was resected with the nerve-sparing operation than wi th the conventional technique. Seventeen patients (42%) had lymph node meta stases and in five patients tumor deposits were found in the perispinous ti ssue next to the inferior hypogastric (pelvic) plexus. The median duration of suprapubic bladder drainage was 11 days (range, 7-30). There was no evid ence of permanent bladder dysfunction. Two patients developed intraperitone al recurrence. Conclusions: Nerve-sparing radical hysterectomy appears to improve the ther apeutic index of the surgical treatment of the operable stages of cervical cancer. Future reports will provide urodynamic and other objective data.