Advertisement

The Urodynamics and Survival Outcomes of Different Methods of Dissecting the Inferior Hypogastric Plexus in Laparoscopic Nerve-Sparing Radical Hysterectomy of Type C: A Randomized Controlled Study

  • Lei Li
  • Shuiqing Ma
  • Xianjie Tan
  • Sen Zhong
  • Ming WuEmail author
Urologic Oncology

Abstract

Background

Little data exist about the impact of dissection methods on bladder function during nerve-sparing radical hysterectomy (NSRH). This randomized controlled trial compared the urodynamic and survival outcomes of different methods dissecting the inferior hypogastric plexus (IHP) during laparoscopic NSRH.

Methods

Eligible patients presenting with stage IB cervical cancer from 9 May 2013 to 27 October 2015 were randomized at a ratio of 1:1 and subjected to waterjet (study group) or traditional blunt (control group) dissection of the IHP for laparoscopic type C radical hysterectomy. Participants were subjected to urodynamic evaluations before and after NSRH. The primary measurement was the proportion of patients with residual urine (RU) ≤ 100 ml, while secondary measurements included urodynamic parameters, disease-free survival (DFS), and overall survival (OS).

Results

In total, 191 women met the inclusion criteria, and 160 patients were included in the final analysis, with 80 randomized to each group. At 14 days after NSRH, the study group had more patients with RU ≤ 100 ml than the control group (82.5% vs. 62.5%, p = 0.005). The study group had similar urodynamic outcomes of preoperative and postoperative tests. Comparison with the study group and preoperative tests revealed the control group had significant bladder function impairment at 4 months after NSRH. After a median follow-up of 33 months, the dissection methods had no significant impact on DFS or OS.

Conclusions

Waterjet dissection of the IHP in laparoscopic NSRH resulted in a more rapid return of normal urodynamics without compromising survival outcome.

ClinicalTrials.gov Identifiers NCT03015376 (PUMCH-OBGYN-2013), NCT03291236 (SOCM-1).

Notes

Acknowledgments

The authors acknowledge their thanks to Prof. Lan Zhu from the Department of Obstetrics and Gynecology, PUMCH, for the directions regarding urodynamic tests and their implications. They also acknowledge their thanks to Prof. Quancai Cui from the Department of Pathology, PUMCH, for assistance with the pathological evaluations.

Funding

This study was supported by the Chinese Academy of Medical Sciences Initiative for Innovative Medicine (CAMS-2017-I2M-1-002).

DISCLOSURE

All authors declare that they have no conflict of interest.

Supplementary material

10434_2019_7228_MOESM1_ESM.tif (457 kb)
Supplementary material 1 (TIFF 456 kb)
10434_2019_7228_MOESM2_ESM.docx (21 kb)
Supplementary material 2 (DOCX 20 kb)
10434_2019_7228_MOESM3_ESM.docx (18 kb)
Different dissection methods for the inferior hypogastric plexus (IHP) did not have an impact on the disease-free survival (A, log rank test P = 0.897) and overall survival (B, log rank test P = 0295) (DOCX 18 kb)

References

  1. 1.
    Zullo MA, Manci N, Angioli R, Muzii L, Panici PB. Vesical dysfunctions after radical hysterectomy for cervical cancer: a critical review. Crit. Rev. Oncol. Hematol. 2003;48:287–93.CrossRefGoogle Scholar
  2. 2.
    Xue Z, Zhu X, Teng Y. Comparison of nerve-sparing radical hysterectomy and radical hysterectomy: a systematic review and meta-analysis. Cell Physiol. Biochem. 2016;38:1841–50.CrossRefGoogle Scholar
  3. 3.
    Kim HS, Kim K, Ryoo SB, et al. Conventional versus nerve-sparing radical surgery for cervical cancer: a meta-analysis. J. Gynecol. Oncol. 2015;26:100–10.CrossRefGoogle Scholar
  4. 4.
    Kanao H, Fujiwara K, Ebisawa K, Hada T, Ota Y, Andou M. Various types of total laparoscopic nerve-sparing radical hysterectomies and their effects on bladder function. J. Gynecol. Oncol. 2014;25:198–205.CrossRefGoogle Scholar
  5. 5.
    Todo Y, Kuwabara M, Watari H, et al. Urodynamic study on postsurgical bladder function in cervical cancer treated with systematic nerve-sparing radical hysterectomy. Int. J. Gynecol. Cancer 2006;16:369–75.CrossRefGoogle Scholar
  6. 6.
    Maneschi F. Urodynamic study of bladder function following nerve sparing radical hysterectomy. J. Gynecol. Oncol. 2014;25:159–61.CrossRefGoogle Scholar
  7. 7.
    Maneschi F, Ianiri P, Sarno M, Gagliardi F, Panici PB. Nerve-sparing class III–IV radical hysterectomy: urodynamic study and surgical technique. Int. J. Gynecol. Cancer 2012;22:675–80.CrossRefGoogle Scholar
  8. 8.
    Kruppa J, Kavvadias T, Amann S, Baessler K, Schuessler B. Short and long-term urodynamic and quality of life assessment after nerve sparing radical hysterectomy: a prospective pilot study. Eur. J. Obstet. Gynecol. Reprod. Biol. 2016;201:131–4.CrossRefGoogle Scholar
  9. 9.
    Roh JW, Lee DO, Suh DH, et al. Efficacy and oncologic safety of nerve-sparing radical hysterectomy for cervical cancer: a randomized controlled trial. J. Gynecol. Oncol. 2015;26:90–9.CrossRefGoogle Scholar
  10. 10.
    Rob L, Halaska M, Robova H. Nerve-sparing and individually tailored surgery for cervical cancer. Lancet Oncol. 2010;11:292–301.CrossRefGoogle Scholar
  11. 11.
    Cibula D, Abu-Rustum NR, Benedetti-Panici P, et al. New classification system of radical hysterectomy: emphasis on a three-dimensional anatomic template for parametrial resection. Gynecol. Oncol. 2011;122:264–8.CrossRefGoogle Scholar
  12. 12.
    Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol. 2008;9:297–303.CrossRefGoogle Scholar
  13. 13.
    Common Terminology Criteria for Adverse Events (CTCAE) v4.03. http://evs.nci.nih.gov/ftp1/CTCAE/. Accessed 10 Dec 2012.
  14. 14.
    Du R, Li L, Ma S, Tan X, Zhong S, Wu M. Lymph nodes metastasis in cervical cancer: Incidences, risk factors, consequences and imaging evaluations. Asia Pac. J. Clin. Oncol. 2018;14:e380–e385.CrossRefGoogle Scholar
  15. 15.
    Haylen BT, de Ridder D, Freeman RM, et al. An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol. Urodyn. 2010;29:4–20.Google Scholar
  16. 16.
    Possover M, Stober S, Plaul K, Schneider A. Identification and preservation of the motoric innervation of the bladder in radical hysterectomy type III. Gynecol. Oncol. 2000;79:154–7.CrossRefGoogle Scholar
  17. 17.
    Trimbos JB, Maas CP, Deruiter MC, Peters AA, Kenter GG. A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients. Int. J. Gynecol. Cancer 2001;11:180–6.CrossRefGoogle Scholar
  18. 18.
    Kato K, Suzuka K, Osaki T, Tanaka N. Unilateral or bilateral nerve-sparing radical hysterectomy: a surgical technique to preserve the pelvic autonomic nerves while increasing radicality. Int. J. Gynecol. Cancer 2007;17:1172–8.CrossRefGoogle Scholar
  19. 19.
    Shi R, Wei W, Jiang P. Laparoscopic nerve-sparing radical hysterectomy for cervical carcinoma: emphasis on nerve content in removed cardinal ligaments. Int. J. Gynecol. Cancer 2016;26:192–198.CrossRefGoogle Scholar
  20. 20.
    Liu Z, Li X, Tao Y, et al. Clinical efficacy and safety of laparoscopic nerve-sparing radical hysterectomy for locally advanced cervical cancer. Int. J. Surg. 2016;25:54–58.CrossRefGoogle Scholar
  21. 21.
    Oda Y, Todo Y, Hanley S, et al. Risk factors for persistent low bladder compliance after radical hysterectomy. Int. J. Gynecol. Cancer 2011;21:167–72.CrossRefGoogle Scholar
  22. 22.
    Pieterse QD, Kenter GG, Maas CP, et al. Self-reported sexual, bowel and bladder function in cervical cancer patients following different treatment modalities: longitudinal prospective cohort study. Int. J. Gynecol. Cancer 2013;23:1717–25.CrossRefGoogle Scholar
  23. 23.
    Kim HS, Kim TH, Suh DH, et al. Success factors of laparoscopic nerve-sparing radical hysterectomy for preserving bladder function in patients with cervical cancer: a protocol-based prospective cohort study. Ann. Surg. Oncol. 2015;22:1987–95.CrossRefGoogle Scholar
  24. 24.
    Hao M, Wang Z, Wei F, Wang J, Wang W, Ping Y. Cavitron ultrasonic surgical aspirator in laparoscopic nerve-sparing radical hysterectomy: a pilot study. Int. J. Gynecol. Cancer 2016;26(3):594–9.CrossRefGoogle Scholar
  25. 25.
    Katahira A, Niikura H, Kaiho Y, et al. Intraoperative electrical stimulation of the pelvic splanchnic nerves during nerve-sparing radical hysterectomy. Gynecol. Oncol. 2005;98:462–6.CrossRefGoogle Scholar
  26. 26.
    Chen CL, Guo HX, Yu YH, et al. The measurement of vesical detrusor electromyographic activity during nerve-sparing radical hysterectomy. Reprod. Sci. 2010;17:1144–52.CrossRefGoogle Scholar
  27. 27.
    Tschan CA, Tschan K, Krauss JK, Oertel J. New applicator improves waterjet dissection quality. Br. J. Neurosurg. 2010;24:641–7.CrossRefGoogle Scholar
  28. 28.
    Tschan CA, Keiner D, Muller HD, et al. Waterjet dissection of peripheral nerves: an experimental study of the sciatic nerve of rats. Neurosurgery 2010;67:368–76.Google Scholar
  29. 29.
    Moinzadeh A, Hasan W, Spaliviero M, et al. Water jet assisted laparoscopic partial nephrectomy without hilar clamping in the calf model. J. Urol. 2005;174:317–21.CrossRefGoogle Scholar
  30. 30.
    Glybochko PV, Alyaev YG, Rapoport LM, et al. The role of waterjet dissection in improving erectile function and continence after nerve-sparing prostatectomy [in Russian]. Urologiia 2017;(1):43–49.CrossRefGoogle Scholar
  31. 31.
    Izquierdo-Luna JS, Campos-Salcedo JG, Estrada-Carrasco CE, Torres-Gomez JJ, Lopez-Silvestre JC, Zapata-Villalba MA. Robot-assisted laparoscopic partial nephrectomy with hydrodissection. Actas Urol. Esp. 2016;40:333–6.CrossRefGoogle Scholar
  32. 32.
    Corvin S, Sturm W, Schlatter E, Anastasiadis A, Kuczyk M, Stenzl A. Laparoscopic retroperitoneal lymph-node dissection with the waterjet is technically feasible and safe in testis-cancer patient. J. Endourol. 2005;19:823–6.CrossRefGoogle Scholar
  33. 33.
    Shekarriz B, Upadhyay J, Jewett MA. Nerve-sparing retroperitoneal lymphadenectomy using hydro-jet dissection: initial experience. J. Endourol. 2004;18:273–6.CrossRefGoogle Scholar
  34. 34.
    Magistro G, Chapple CR, Elhilali M, et al. Emerging minimally invasive treatment options for male lower urinary tract symptoms. Eur. Urol. 2017;72:986–997.CrossRefGoogle Scholar
  35. 35.
    Granick M, Rubinsky L, Parthiban C, Shanmugam M, Ramasubbu N. Dispersion risk associated with surgical debridement devices. Wounds 2017;29:E88–E91.CrossRefGoogle Scholar
  36. 36.
    Contin P, Kulu Y, Bruckner T, et al. Comparative analysis of late functional outcome following preoperative radiation therapy or chemoradiotherapy and surgery or surgery alone in rectal cancer. Int. J. Colorectal Dis. 2014;29:165–75.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyPeking Union Medical College HospitalBeijingChina

Personalised recommendations