Introducing nerve-sparing approach during minimally invasive radical hysterectomy for locally-advanced cervical cancer: A multi-institutional experience

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To evaluate the impact of nerve-sparing (NS) approach on outcomes of patients undergoing minimally invasive radical hysterectomy (MRH) for locally advanced stage cervical cancer (LACC).

METHODS: Data of consecutive patients undergoing minimally invasive surgery for LACC were retrospectively retrieved in a multi-institutional setting from 2009 to 2016. All patients included had minimally invasive class III radical hysterectomy (MRH or NS-MRH). Propensity matching algorithm was used to decrease possible allocation bias when comparing outcomes between groups.

RESULTS: Overall, 83 patients were included. The prevalence of patients undergoing NS approach increased aver the study period (from 7% in the year 2009-2010 to 97% in the year 2015-2016; p-for-trend < 0.001). NS-MRH and MRH were performed in 47 (57%) and 36 (43%) patients, respectively. After the application the propensity-matching algorithm, we compared 35 patients' pair (total 70 patients). Postoperative complications rate was similar between groups. Patients undergoing NS-LRH experienced shorter hospital stay than patients undergoing LRH (3.6 vs. 5.0 days). 60-day pelvic floor dysfunction rates, including voiding, fecal and sexual alterations, were lower in the NS group in comparison to control group (p = 0.02). Five-year disease-free (p = 0.77) and overall (p = 0.36) survivals were similar comparing NS-MRH with MRH.

CONCLUSIONS: The implementation of NS approach in the setting of LACC improves patients' outcomes, minimizing pelvic dysfunction rates. NS approach has not detrimental effects on survival outcomes.

Original languageEnglish
Pages (from-to)2150-2156
Number of pages7
JournalEuropean Journal of Surgical Oncology
Volume43
Issue number11
DOIs
Publication statusPublished - Nov 2017

Fingerprint

Hysterectomy
Uterine Cervical Neoplasms
Pelvic Floor
Minimally Invasive Surgical Procedures
Survival
Length of Stay
Control Groups

Keywords

  • Algorithms
  • Female
  • Humans
  • Hysterectomy
  • Middle Aged
  • Minimally Invasive Surgical Procedures
  • Propensity Score
  • Retrospective Studies
  • Treatment Outcome
  • Uterine Cervical Neoplasms
  • Journal Article
  • Multicenter Study

Cite this

@article{983a4c73eb2745a8ab1fc259a2129bd6,
title = "Introducing nerve-sparing approach during minimally invasive radical hysterectomy for locally-advanced cervical cancer: A multi-institutional experience",
abstract = "OBJECTIVE: To evaluate the impact of nerve-sparing (NS) approach on outcomes of patients undergoing minimally invasive radical hysterectomy (MRH) for locally advanced stage cervical cancer (LACC).METHODS: Data of consecutive patients undergoing minimally invasive surgery for LACC were retrospectively retrieved in a multi-institutional setting from 2009 to 2016. All patients included had minimally invasive class III radical hysterectomy (MRH or NS-MRH). Propensity matching algorithm was used to decrease possible allocation bias when comparing outcomes between groups.RESULTS: Overall, 83 patients were included. The prevalence of patients undergoing NS approach increased aver the study period (from 7{\%} in the year 2009-2010 to 97{\%} in the year 2015-2016; p-for-trend < 0.001). NS-MRH and MRH were performed in 47 (57{\%}) and 36 (43{\%}) patients, respectively. After the application the propensity-matching algorithm, we compared 35 patients' pair (total 70 patients). Postoperative complications rate was similar between groups. Patients undergoing NS-LRH experienced shorter hospital stay than patients undergoing LRH (3.6 vs. 5.0 days). 60-day pelvic floor dysfunction rates, including voiding, fecal and sexual alterations, were lower in the NS group in comparison to control group (p = 0.02). Five-year disease-free (p = 0.77) and overall (p = 0.36) survivals were similar comparing NS-MRH with MRH.CONCLUSIONS: The implementation of NS approach in the setting of LACC improves patients' outcomes, minimizing pelvic dysfunction rates. NS approach has not detrimental effects on survival outcomes.",
keywords = "Algorithms, Female, Humans, Hysterectomy, Middle Aged, Minimally Invasive Surgical Procedures, Propensity Score, Retrospective Studies, Treatment Outcome, Uterine Cervical Neoplasms, Journal Article, Multicenter Study",
author = "Francesco Raspagliesi and Giorgio Bogani and Arsenio Spinillo and Antonino Ditto and Stefano Bogliolo and Jvan Casarin and {Leone Roberti Maggiore}, Umberto and Fabio Martinelli and Mauro Signorelli and Barbara Gardella and Valentina Chiappa and Cono Scaffa and Simone Ferrero and Antonella Cromi and Domenica Lorusso and Fabio Ghezzi",
note = "Copyright {\circledC} 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.",
year = "2017",
month = "11",
doi = "10.1016/j.ejso.2017.08.015",
language = "English",
volume = "43",
pages = "2150--2156",
journal = "European Journal of Surgical Oncology",
issn = "0748-7983",
publisher = "W.B. Saunders Ltd",
number = "11",

}

TY - JOUR

T1 - Introducing nerve-sparing approach during minimally invasive radical hysterectomy for locally-advanced cervical cancer

T2 - A multi-institutional experience

AU - Raspagliesi, Francesco

AU - Bogani, Giorgio

AU - Spinillo, Arsenio

AU - Ditto, Antonino

AU - Bogliolo, Stefano

AU - Casarin, Jvan

AU - Leone Roberti Maggiore, Umberto

AU - Martinelli, Fabio

AU - Signorelli, Mauro

AU - Gardella, Barbara

AU - Chiappa, Valentina

AU - Scaffa, Cono

AU - Ferrero, Simone

AU - Cromi, Antonella

AU - Lorusso, Domenica

AU - Ghezzi, Fabio

N1 - Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

PY - 2017/11

Y1 - 2017/11

N2 - OBJECTIVE: To evaluate the impact of nerve-sparing (NS) approach on outcomes of patients undergoing minimally invasive radical hysterectomy (MRH) for locally advanced stage cervical cancer (LACC).METHODS: Data of consecutive patients undergoing minimally invasive surgery for LACC were retrospectively retrieved in a multi-institutional setting from 2009 to 2016. All patients included had minimally invasive class III radical hysterectomy (MRH or NS-MRH). Propensity matching algorithm was used to decrease possible allocation bias when comparing outcomes between groups.RESULTS: Overall, 83 patients were included. The prevalence of patients undergoing NS approach increased aver the study period (from 7% in the year 2009-2010 to 97% in the year 2015-2016; p-for-trend < 0.001). NS-MRH and MRH were performed in 47 (57%) and 36 (43%) patients, respectively. After the application the propensity-matching algorithm, we compared 35 patients' pair (total 70 patients). Postoperative complications rate was similar between groups. Patients undergoing NS-LRH experienced shorter hospital stay than patients undergoing LRH (3.6 vs. 5.0 days). 60-day pelvic floor dysfunction rates, including voiding, fecal and sexual alterations, were lower in the NS group in comparison to control group (p = 0.02). Five-year disease-free (p = 0.77) and overall (p = 0.36) survivals were similar comparing NS-MRH with MRH.CONCLUSIONS: The implementation of NS approach in the setting of LACC improves patients' outcomes, minimizing pelvic dysfunction rates. NS approach has not detrimental effects on survival outcomes.

AB - OBJECTIVE: To evaluate the impact of nerve-sparing (NS) approach on outcomes of patients undergoing minimally invasive radical hysterectomy (MRH) for locally advanced stage cervical cancer (LACC).METHODS: Data of consecutive patients undergoing minimally invasive surgery for LACC were retrospectively retrieved in a multi-institutional setting from 2009 to 2016. All patients included had minimally invasive class III radical hysterectomy (MRH or NS-MRH). Propensity matching algorithm was used to decrease possible allocation bias when comparing outcomes between groups.RESULTS: Overall, 83 patients were included. The prevalence of patients undergoing NS approach increased aver the study period (from 7% in the year 2009-2010 to 97% in the year 2015-2016; p-for-trend < 0.001). NS-MRH and MRH were performed in 47 (57%) and 36 (43%) patients, respectively. After the application the propensity-matching algorithm, we compared 35 patients' pair (total 70 patients). Postoperative complications rate was similar between groups. Patients undergoing NS-LRH experienced shorter hospital stay than patients undergoing LRH (3.6 vs. 5.0 days). 60-day pelvic floor dysfunction rates, including voiding, fecal and sexual alterations, were lower in the NS group in comparison to control group (p = 0.02). Five-year disease-free (p = 0.77) and overall (p = 0.36) survivals were similar comparing NS-MRH with MRH.CONCLUSIONS: The implementation of NS approach in the setting of LACC improves patients' outcomes, minimizing pelvic dysfunction rates. NS approach has not detrimental effects on survival outcomes.

KW - Algorithms

KW - Female

KW - Humans

KW - Hysterectomy

KW - Middle Aged

KW - Minimally Invasive Surgical Procedures

KW - Propensity Score

KW - Retrospective Studies

KW - Treatment Outcome

KW - Uterine Cervical Neoplasms

KW - Journal Article

KW - Multicenter Study

U2 - 10.1016/j.ejso.2017.08.015

DO - 10.1016/j.ejso.2017.08.015

M3 - Article

C2 - 28927778

VL - 43

SP - 2150

EP - 2156

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

SN - 0748-7983

IS - 11

ER -