Nerve Sparing Radical Hysterectomy (Nsrh) For Cervical Cancer (Cc). Preliminary Results

To present the surgical technique, its feasibility, results and survival. 73 pts. stages Ib1-IIb CC underwent NSRH between 5/02 and 10/05. Stages Ib2- IIb received neoadjuvant chemotherapy. Pts were submitted to a standardized questionnaire and urodynamic evaluation before and after surgery. Surgical technique included four steps: 1- dissection of the hypogastric nerve in the sacrouterine ligament. 2- Dissection of the inferior hypogastric plexus in the lateral parametrium. 3- Mobilization in the vesicouterine ligament followed by anterior ligament transection. 4- Transection of the ligaments. Follow-up ranged 5 to 41 months. Results were compared to a historic control group (n = 72) with no NSRH. Nerve sparing was performed in all cases. In 5/73 cases (6.8%) urodynamic evaluation was altered vs. 26.3% (19/72) in the control group (p , 0.003). No differences in constipation were observed. In the NSRH group no differences were found between pre and postsurgical urodynamic evaluation. A patient died (1.36 %) by intercurrent disease, and 2 (2.7%) by CC; 3 pts (4.1%) relapsed locally and 2 (2.73%) developed pelvic and distant recurrences in the NSRH group. Disease free survival was 93.1% and overall survival 95.9%. No differences in the surgical specimens were verified between both groups. The NSRH is feasible, with low complications and morbidity, without diminishing survival.