Laparoscopic Nerve-sparing Radical Hysterectomy And Laparoscopic Radical Hysterectomy In Cervical Cancer:a Systematic Evaluation

Objectives: To evaluate the safety and efficacy of laparoscopic nerve-sparing radical hysterectomy(LNSRH)and traditional laparoscopic radical hysterectomy(LRH)in the treatment of cervical cancer by meta-analysis.Methods: Literatures from PubMed,Embase,China HowNet and Wan fang databases up to December 2018 were retrieved.The bias risk of cohort study was evaluated by Newcastle-Ottawa Scale(NOS),and the bias risk assessment tool recommended by Cochrane Manual Version 5.1.0 was used to evaluate the bias risk of RCT.Revman 5.3 software was used for data analysis and processing.Results: A total of 27 articles were included,including 4 in English and 23 in Chinese.A total of 2849 patients,of which 1245 cases were in the LNSRH group and the other 1244 cases were in the LRH group.Meta-analysis showed that there was no significant difference between LNSRH group and LRH group in intraoperative bleeding volume[MD=-3.12,95% CI(-15.90,9.67),P=0.63],number of lymph node resection[MD= 0.14,95% CI(-0.60,0.87),P=0.72] and postoperative complications[OR=0.74,95% CI(0.45,1.21),P=0.23].LNSRH group was shorter than traditional LRH group in hospitalization days [MD=-2.75,95% CI(-3.95,-1.55),P<0.00001],time of indwelling urinary catheter after operation[MD=-6.63,95% CI(-7.56,-5.69),P<0.00001],first exhaust of anus time[SMD=-1.56,95% CI(-2.11,-1.01),P<0.00001],first defecation time[SMD=-1.43,95% CI(-1.60,-1.25),P<0.00001],scope of parametrial resection [MD=-0.05,95% CI(-0.09,-0.02),P=0.004]and length of vaginal resection[MD=-0.05,95% CI(-0.09,-0.01),P=0.01],while the operation time [MD=25.31,95% CI(5.25,45.37),P=0.01] was longer than the latter group.The incidence of bladder dysfunction [OR=0.26,95% CI(0.20,0.34),P < 0.0001],rectal dysfunction [OR=0.31,95% CI(0.17,0.58),P=0.0002] and sexual dysfunction in LNSRH group was less than that in LRH group.Conclusion: Current evidence shows that compared with traditional LRH,LNSRH has no statistical significance in intraoperative bleeding volume,number of lymphadenectomies and postoperative complications,LNSRH is shorter than LRH in hospitalization days,time of indwelling urinary catheter and scope of parametrial resection,length of vaginal resection,time of first anal exhaust and defecation.The incidence of bladder dysfunction,rectal dysfunction and sexual dysfunction in LNSRH group was less than that in LRH group,while the operation time was longer.And there was no significant difference in the survival time and long-term prognosis between LNSRH and LRH.In a word,LNSRH is a safe and effective way to treat cervical cancer.It can significantly improve the recovery of bladder and intestinal and sexual function after operation without affecting the prognosis of the disease.