Clinical Research Papers:
An improved nerve-sparing radical hysterectomy technique for cervical cancer using the paravesico-vaginal space as a new surgical landmark
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Yuqin Zhang1,*, Tingyan Shi1,*, Sheng Yin1, Sining Ma1, Di Shi1, Jun Guan2,3, Libing Xiang4, Yang Liu4, Yulan Ren4, Deyan Tan5 and Rongyu Zang1
1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Zhongshan Hospital, Fudan University, Shanghai, China
2Department of Gynecology, Tumor Bank Ovarian Cancer, European Competence Center for Ovarian Cancer, Campus Virchow Clinic, Charité Medical University of Berlin, Berlin, Germany
3Nuffield Department of Obstetrics and Gynecology, University of Oxford, Oxford, United Kingdom
4Department of Gynecologic Oncology, Fudan University Cancer Center, Shanghai, China
5Department of Anatomy, Shanghai Medical College, Fudan University, Shanghai, China
*These authors contributed equally to the work
Rongyu Zang, email: [email protected]
Keywords: paravesico-vaginal space, nerve-sparing radical hysterectomy, deep uterine vein, terminal ureter, cervical cancer
Received: April 11, 2017 Accepted: June 16, 2017 Published: July 05, 2017
Bladder dysfunction remains a major postoperative challenge for early stage cervical cancer patients. The present prospective phase 2 trial in patients with stage IB1 and IIA1 cervical cancer follows up on our previous, unpublished work describing a new surgical landmark, the paravesico-vaginal space. We describe a novel nerve-sparing radical hysterectomy (NSRH) approach to treat early stage cervical cancer without compromising local control rate or survival. Between September 2015 and August 2016, 49 patients were enrolled to receive NSRH. The bladder catheter was routinely removed on postoperative day 4. The primary endpoints were rate of postvoid residual urine volume (PVR) ≤ 50 ml and proportion of patients with successful catheter removal (ClinicalTrials.gov Identifier: NCT02562729). Anatomically, from ventral to dorsal, the terminal ureter, deep uterine vein, and cardinal ligament were the three markers of the paravesico-vaginal space. The median operative time was 100 min, and the median blood loss was 200 ml. Thirty-four patients (69.4%) had successful catheter removal on postoperative day 4, and 17 patients (34.7%) had a PVR ≤ 50 ml. Our results suggest that by accessing the paravesico-vaginal space landmark, the bladder branch of the inferior hypogastric plexus can be completely preserved, contributing to greater NSRH efficiency without compromising outcomes for patients with early stage cervical cancer.
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